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Nagata H, Komatsu H, Yamamoto K, Okawa M, Hikino K, Iida Y, Wada I, Ikebuchi A, Sawada M, Azuma Y, Sato S, Harada T, Taniguchi F. Comparison of surgical outcomes of da Vinci surgical systems X and Xi: A single-center study. Asian J Endosc Surg 2024; 17:e13358. [PMID: 38986520 DOI: 10.1111/ases.13358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND The da Vinci surgical systems (X and Xi) are fourth-generation systems marketed by Intuitive Inc. The X system is less expensive than the Xi system. This study compared the surgical outcomes of patients who underwent hysterectomy using the X and Xi systems. METHODS Data from 172 patients who underwent robot-assisted total hysterectomies by four surgeons between April 2019 and March 2023 were retrospectively analyzed in a single-center study. The patients were divided into two groups based on the surgical system used. Approval was granted by the Institutional Review Board of the Tottori University Hospital (22A134). All patients provided opt-out consent in accordance with the institutional guidelines. RESULTS Operative time (126.6 ± 29.5 for X, 138.2 ± 38.5 for Xi, p = .227) and console time (92.9 ± 27.0 for X, 105.5 ± 34.7 for Xi, p = .089) were insignificantly shorter in group X than in group Xi after propensity score matching for age, body mass index, nulliparity, previous history of abdominal or pelvic surgery, preoperative diagnosis, and surgical approach. No significant differences between X and Xi were observed in a subgroup analysis of patients who underwent robot-assisted total laparoscopic hysterectomy without lymphadenectomy (operative time: 199.0 ± 26.5 for X, 221.5 ± 45.1 for Xi, p = .227; console time: 162.1 ± 25.0 for X, 178.3 ± 0.314 for Xi, p = .314). CONCLUSION Perioperative outcomes for the X and Xi da Vinci surgical systems were equivalent. The cost-effective X system may allow the widespread use of robotic surgeries.
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Affiliation(s)
- Hiroki Nagata
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Koji Yamamoto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Masayo Okawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Kohei Hikino
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Ikumi Wada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Ai Ikebuchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Mayumi Sawada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Yukihiro Azuma
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Yonago, Japan
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Natarajan P, Delanerolle G, Dobson L, Xu C, Zeng Y, Yu X, Marston K, Phan T, Choi F, Barzilova V, Powell SG, Wyatt J, Taylor S, Shi JQ, Hapangama DK. Surgical Treatment for Endometrial Cancer, Hysterectomy Performed via Minimally Invasive Routes Compared with Open Surgery: A Systematic Review and Network Meta-Analysis. Cancers (Basel) 2024; 16:1860. [PMID: 38791939 PMCID: PMC11119247 DOI: 10.3390/cancers16101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/06/2024] [Accepted: 04/27/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Total hysterectomy with bilateral salpingo-oophorectomy via minimally invasive surgery (MIS) has emerged as the standard of care for early-stage endometrial cancer (EC). Prior systematic reviews and meta-analyses have focused on outcomes reported solely from randomised controlled trials (RCTs), overlooking valuable data from non-randomised studies. This inaugural systematic review and network meta-analysis comprehensively compares clinical and oncological outcomes between MIS and open surgery for early-stage EC, incorporating evidence from randomised and non-randomised studies. Methods: This study was prospectively registered on PROSPERO (CRD42020186959). All original research of any experimental design reporting clinical and oncological outcomes of surgical treatment for endometrial cancer was included. Study selection was restricted to English-language peer-reviewed journal articles published 1 January 1995-31 December 2021. A Bayesian network meta-analysis was conducted. Results: A total of 99 studies were included in the network meta-analysis, comprising 181,716 women and 14 outcomes. Compared with open surgery, laparoscopic and robotic-assisted surgery demonstrated reduced blood loss and length of hospital stay but increased operating time. Compared with laparoscopic surgery, robotic-assisted surgery was associated with a significant reduction in ileus (OR = 0.40, 95% CrI: 0.17-0.87) and total intra-operative complications (OR = 0.38, 95% CrI: 0.17-0.75) as well as a higher disease-free survival (OR = 2.45, 95% CrI: 1.04-6.34). Conclusions: For treating early endometrial cancer, minimal-access surgery via robotic-assisted or laparoscopic techniques appears safer and more efficacious than open surgery. Robotic-assisted surgery is associated with fewer complications and favourable oncological outcomes.
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Affiliation(s)
- Purushothaman Natarajan
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Gayathri Delanerolle
- Institute of Applied Health Research, College of Medicine, University of Birmingham, Vincent Drive, Edgbaston B15 2TT, UK
| | - Lucy Dobson
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Cong Xu
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Yutian Zeng
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Xuan Yu
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
| | - Kathleen Marston
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Thuan Phan
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Fiona Choi
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Vanya Barzilova
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Simon G. Powell
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - James Wyatt
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
| | - Sian Taylor
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
| | - Jian Qing Shi
- Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, China
- National Center for Applied Mathematics Shenzhen, Shenzhen 518038, China
| | - Dharani K. Hapangama
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L8 7SS, UK
- Liverpool Women’s Hospital NHS Foundation Trust, Liverpool L8 7SS, UK
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Mokarram Dorri N, Del M, Cannone F, Lefebvre M, Loaec C, Sabiani L, Jauffret C, Blache G, Houvenaeghel G, Carcopino X, Classe JM, Narducci F, Martinez A, Lambaudie E. Is minimally invasive surgical approach a reasonable option in apparent early stage epithelial ovarian cancer restaging? Results from a multicentric retrospective study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107976. [PMID: 38354484 DOI: 10.1016/j.ejso.2024.107976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/22/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024]
Abstract
INTRODUCTION To perform surgical staging of early stage ovarian cancer (EOC), conventional laparoscopy (LS) and robot-assisted laparoscopy (RLS) appear to be reliable procedures compared to open surgery. But oncologicals results with long-term follow up are limited in the literature. The objective of this study is to evaluate the surgical and long-term survival for patients managed by minimally invasive surgery (MIS). MATERIALS AND METHODS We conducted a multicentric retrospective study in 6 institutions. All patients referred for epithelial EOC (apparent stage I-IIa) managed with LS and RLS were involved. RESULTS From December 2008 to December 2017, 140 patients were included (109 in LS group and 31 in RLS group). A total of 27 (19.2 %) patients were upstaged to an advanced ovarian cancer (FIGO stage > IIA), and 73 % of patients received chemotherapy. Mean operative time was 265,8 ± 88,4 min and significantly longer in RLS group (LS = 254,5 ± 86,8; RLS = 305,6 ± 85,5; p = 0,008). Rate of severe post-operative complications (grade 3) was 5,7 %. Thirteen conversion to laparotomy occurred, including one per-operative hemorrhaege. After a mean follow-up of 60,7 months, 29 (20.7 %) patients recurred, with a time to recurrence was >24 months in 51,7 % of cases. Overall survival (OS) was 88.6 % and disease-free survival (DFS) was 79.3 %. Oncologic outcomes were similar between LS and RLS group (OS: p = 0,504 and DFS: p = 0,213). CONCLUSION Surgical staging of EOC by LS or RLS approach has long-term equivalent surgical and oncological approach. These results seem to be equivalent to open surgery according to literature review.
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Affiliation(s)
| | - Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Francesco Cannone
- Department of Obstetrics and Gynecology, Azienda di Rilievo Nazionale e Alta Specializzazione (ARNAS) Garibaldi, Catania, Italy
| | - Manon Lefebvre
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Cecile Loaec
- Department of Surgery, Institut de Cancerologie de l'Ouest, Boulevard Professor Monod, 44805, Saint Herblain, France
| | - Laura Sabiani
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Camille Jauffret
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Guillaume Blache
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Gilles Houvenaeghel
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France; Inserm, CNRS, Institut Paoli Calmettes, CRCM, Aix Marseille Univ, Marseille, France
| | - Xavier Carcopino
- Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), University Avignon, CNRS, IRD, IMBE, UMR 7263, Marseille, France
| | - Jean-Marc Classe
- Department of Surgery, Institut de Cancerologie de l'Ouest, Boulevard Professor Monod, 44805, Saint Herblain, France
| | - Fabrice Narducci
- Department of Surgical Oncology, Oscar Lambret Cancer Centre, Lille, Hauts-de-France, France
| | - Alejandra Martinez
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Eric Lambaudie
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France; Inserm, CNRS, Institut Paoli Calmettes, CRCM, Aix Marseille Univ, Marseille, France
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Nilsson W, Schmidt M, Turner L, Shepherd J. Comparing Postoperative Pain With Laparoscopic Versus Robotic Sacrocolpopexy. J Minim Invasive Gynecol 2024; 31:200-204. [PMID: 38013160 DOI: 10.1016/j.jmig.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 11/29/2023]
Abstract
STUDY OBJECTIVE To compare postoperative pain and pain-related outcomes after laparoscopic (LS-MISC) vs robotic minimally invasive sacrocolpopexy (R-MISC). DESIGN A secondary analysis of an original placebo-controlled randomized controlled trial (RCT) examining preoperative intravenous (IV) acetaminophen on postoperative pain after MISC. SETTING Planned secondary analysis of multicenter RCT. PATIENTS Women undergoing MISC. INTERVENTIONS Coprimary outcomes at 24 hours were total opioid use in morphine milligram equivalents (MMEs) and visual analog scale (VAS) pain scores comparing LS-MISC and R-MISC. The secondary outcome was pain scores using a pain diary through 7 days after the procedure. MEASUREMENTS AND MAIN RESULTS The original study was a double-blind, multicenter, RCT comparing IV acetaminophen with placebo that took place between 2014 and 2017. Given that the original trial was unable to show an impact from the use of IV acetaminophen, our analysis focused on the impact of surgical modality. We included 90 subjects undergoing MISC: 65 LS-MISC and 25 R-MISC. Most were Caucasian (97.8%) and postmenopausal (88.9%) with mean age of 61.2 ± 7.2 years and body mass index of 27.6 ± 4.4 kg/m2. IV acetaminophen did not affect pain in the original study and was not different between LS-MISC and R-MISC. Concomitant hysterectomy was performed in 67% (LS-MISC) vs 60% (R-MISC, p = .49). LS-MISC underwent more perineorrhaphies (15.4% vs 0%, p = .04) and posterior repairs (18.5% vs 0%, p = .02). Operative time was longer with LS-MISC (208.5 ± 57.3 vs 143.6 ± 21.0 minutes, p <.01). Length of stay was longer with LS-MISC (0.9 ± 0.4 vs 0.7 ± 0.4 days, p = .02). Women undergoing LS-MISC consumed more opioid MMEs through 24 hours when including intraoperative opioids (48.5 ± 25.5 vs 35.1 ± 14.6 MME, p <.01). Using linear regression correcting for operative time and concomitant vaginal repairs, this difference disappeared. Likewise, when intraoperative opioids were excluded, there was no difference. There were no differences in 24-hour postoperative VAS scores, opioid use in the first week, or quality of life (Patient-Reported Outcomes Measurement Information System - Pain Interference Short Form, all p <.05). CONCLUSION When comparing VAS pain scores, MME opioid usage, and quality of life between LS-MISC and R-MISC, either there was no difference or differences disappeared after adjusting for confounders. Overall, opioid use, pain scores, and opioid side effects were low.
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Affiliation(s)
- Wesley Nilsson
- Division of Minimally Invasive Gynecological Surgery, Department of Obstetrics and Gynecology, UConn Health - John Dempsy Hospital, Farmington, Connecticut (Drs. Nilsson and Shepherd).
| | - Megan Schmidt
- Department of Obstetrics/Gynecology, Trinity Health of New England, Hartford, Connecticut (Dr. Schmidt)
| | - Lindsay Turner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Allegheny Health Network, and the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania (Drs. Turner and Shepherd)
| | - Jonathan Shepherd
- Division of Minimally Invasive Gynecological Surgery, Department of Obstetrics and Gynecology, UConn Health - John Dempsy Hospital, Farmington, Connecticut (Drs. Nilsson and Shepherd); Division of Urogynecology, Department of Obstetrics and Gynecology, Allegheny Health Network, and the Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh, Pennsylvania (Drs. Turner and Shepherd)
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Xiao P, Li L, Qu J, Wang G. Global research hotspots and trends on robotic surgery in obstetrics and gynecology: a bibliometric analysis based on VOSviewer. Front Surg 2024; 11:1308489. [PMID: 38404294 PMCID: PMC10884115 DOI: 10.3389/fsurg.2024.1308489] [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: 10/06/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Over the last two decades, the quantity of papers published in relation to robotic surgery in obstetrics and gynecology has continued to grow globally. However, no bibliometric analysis based on VOSviewer has been performed to evaluate the past and present of global research in the field. In this study, we aimed to analyze the bibliometric characteristics of papers on robotic surgery in obstetrics and gynecology to reveal research hotspots and trends in this field. Methods The Web of Science Core Collection was searched for scientific papers on robotic surgery in obstetrics and gynecology published between January 1, 1998 and December 31, 2023. Bibliometric metadata of each selected paper was extracted for analysis. The results were visualized by VOSviewer (version 1.6.18). Results A total of 1,430 papers met the inclusion criteria. The United States had the highest total link strengths and contributed the most papers (n = 793). The Mayo Clinic produced the largest number of papers (n = 85), and Professor Pedro T Ramirez contributed the most papers (n = 36). The number of citations ranged from 0 to 295 with a total sum of 29,103. The Journal of Minimally Invasive Gynecology published the most relevant papers (n = 252). Keywords were classified into six clusters based on co-occurrence data, of which cluster 1, cluster 4 and cluster 6 had more main keywords with the largest average publication year. Conclusions This is the first VOSviewer-based bibliometric analysis of robotic surgery research in obstetrics and gynecology. The United States was the leading country, and the Journal of Minimally Invasive Gynecology was the most productive journal in the field. Scientists and institutions from around the world should push their boundaries to bring about deep collaboration. The main research topic has always been the use of robotic surgery in the treatment of gynecologic malignancies. More randomized controlled trials need to be conducted to compare surgical outcomes of robotic surgery with other surgical approaches. Robotic sacrocolpopexy for pelvic organ prolapse has become a new research hotspot, and robotic surgery for sentinel lymph node detection in gynecologic malignancies are more potential directions for future research.
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Affiliation(s)
- Peichen Xiao
- Department of Obstetrics and Gynecology, Jinan Central Hospital, Shandong University, Jinan, China
- Innovation Center of Intelligent Diagnosis, Jinan Central Hospital, Shandong University, Jinan, China
| | - Lu Li
- Department of Obstetrics and Gynecology, Jinan Central Hospital, Shandong University, Jinan, China
| | - Jinfeng Qu
- Department of Obstetrics and Gynecology, Jinan Central Hospital, Shandong University, Jinan, China
| | - Guangxin Wang
- Innovation Center of Intelligent Diagnosis, Jinan Central Hospital, Shandong University, Jinan, China
- Shandong Innovation Center of Intelligent Diagnosis, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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Gantschnigg A, Koch OO, Singhartinger F, Tschann P, Hitzl W, Emmanuel K, Presl J. Short-term outcomes and costs analysis of robotic-assisted versus laparoscopic cholecystectomy-a retrospective single-center analysis. Langenbecks Arch Surg 2023; 408:299. [PMID: 37552295 PMCID: PMC10409838 DOI: 10.1007/s00423-023-03037-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Robotic-assisted surgery is an alternative technique for patients undergoing minimal invasive cholecystectomy (CHE). The aim of this study is to compare the outcomes and costs of laparoscopic versus robotic CHE, previously described as the major disadvantage of the robotic system, in a single Austrian tertiary center. METHODS A retrospective single-center analysis was carried out of all patients who underwent an elective minimally invasive cholecystectomy between January 2010 and August 2020 at our tertiary referral institution. Patients were divided into two groups: robotic-assisted CHE (RC) and laparoscopic CHE (LC) and compared according to demographic data, short-term postoperative outcomes and costs. RESULTS In the study period, 2088 elective minimal invasive cholecystectomies were performed. Of these, 220 patients met the inclusion criteria and were analyzed. One hundred ten (50%) patients underwent LC, and 110 patients RC. There was no significant difference in the mean operation time between both groups (RC: 60.2 min vs LC: 62.0 min; p = 0.58). Postoperative length of stay was the same in both groups (RC: 2.65 days vs LC: 2.65 days, p = 1). Overall hospital costs were slightly higher in the robotic group with a total of €2088 for RC versus €1726 for LC. CONCLUSIONS Robotic-assisted cholecystectomy is a safe and feasible alternative to laparoscopic cholecystectomy. Since there are no significant clinical and cost differences between the two procedures, RC is a justified operation for training the whole operation team in handling the system as a first step procedure. Prospective randomized trials are necessary to confirm these conclusions.
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Affiliation(s)
- Antonia Gantschnigg
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria.
| | - Oliver Owen Koch
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Franz Singhartinger
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Peter Tschann
- Department of General and Thoracic Surgery, Academic Teaching Hospital, Feldkirch, Austria
| | - Wolfgang Hitzl
- Department of Ophthalmology and Optometry, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
- Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
- Department of Research and Innovation, Paracelsus Medical University, Salzburg, Austria
| | - Klaus Emmanuel
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
| | - Jaroslav Presl
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University/ Salzburger Landeskliniken (SALK), Salzburg, Austria
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Drymiotou S, Dokmeci M, Chandrasekaran D, Jeyarajah A, Brockbank E. Impact of minimally invasive surgery on surgical outcomes for obese women with endometrial cancer following robotic surgery introduction; a single centre study. Int J Med Robot 2023:e2559. [PMID: 37522379 DOI: 10.1002/rcs.2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND The aim was to assess the surgical outcomes in obese women with endometrial cancer following robotic surgery introduction in a London tertiary gynaecological cancer unit. METHODS Data was prospectively collected for 281 women undergoing endometrial cancer surgery in 2016, 2018 and 2019 (robotic surgery was introduced in November 2017). RESULTS The proportion of obese and morbidly obese patients undergoing minimally invasive surgery (MIS) significantly increased following robotic surgery introduction from 43.8% to 69.6% (p < 0.001). Overall robotic surgery operating time was not affected by higher body mass index (r = 0.177, 95% CI -0.068-0.402). There was no difference in the length of stay or in the frequency and severity of complication rates between obese, morbidly obese and non-obese populations undergoing MIS. CONCLUSION Robotic surgery led to a significant rise in MIS and improved surgical outcomes for obese and morbidly obese women with endometrial cancer within 12 months of its introduction.
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Affiliation(s)
| | - Melin Dokmeci
- Gynaecology Oncology Department, Barts Health NHS Trust, London, UK
| | - Dhivya Chandrasekaran
- Gynaecology Oncology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Arjun Jeyarajah
- Gynaecology Oncology Department, Barts Health NHS Trust, London, UK
| | - Elly Brockbank
- Gynaecology Oncology Department, Barts Health NHS Trust, London, UK
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Abu-Rustum N, Yashar C, Arend R, Barber E, Bradley K, Brooks R, Campos SM, Chino J, Chon HS, Chu C, Crispens MA, Damast S, Fisher CM, Frederick P, Gaffney DK, Giuntoli R, Han E, Holmes J, Howitt BE, Lea J, Mariani A, Mutch D, Nagel C, Nekhlyudov L, Podoll M, Salani R, Schorge J, Siedel J, Sisodia R, Soliman P, Ueda S, Urban R, Wethington SL, Wyse E, Zanotti K, McMillian NR, Aggarwal S. Uterine Neoplasms, Version 1.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2023; 21:181-209. [PMID: 36791750 DOI: 10.6004/jnccn.2023.0006] [Citation(s) in RCA: 102] [Impact Index Per Article: 102.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Adenocarcinoma of the endometrium (also known as endometrial cancer, or more broadly as uterine cancer or carcinoma of the uterine corpus) is the most common malignancy of the female genital tract in the United States. It is estimated that 65,950 new uterine cancer cases will have occurred in 2022, with 12,550 deaths resulting from the disease. Endometrial carcinoma includes pure endometrioid cancer and carcinomas with high-risk endometrial histology (including uterine serous carcinoma, clear cell carcinoma, carcinosarcoma [also known as malignant mixed Müllerian tumor], and undifferentiated/dedifferentiated carcinoma). Stromal or mesenchymal sarcomas are uncommon subtypes accounting for approximately 3% of all uterine cancers. This selection from the NCCN Guidelines for Uterine Neoplasms focuses on the diagnosis, staging, and management of pure endometrioid carcinoma. The complete version of the NCCN Guidelines for Uterine Neoplasms is available online at NCCN.org.
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Affiliation(s)
| | | | | | - Emma Barber
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - Susana M Campos
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | | | | | | | | | | | | | | | | | - Jordan Holmes
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center
| | | | - Jayanthi Lea
- UT Southwestern Simmons Comprehensive Cancer Center
| | | | - David Mutch
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Christa Nagel
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Larissa Nekhlyudov
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | | | - John Schorge
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Rachel Sisodia
- Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | | | - Stefanie Ueda
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | - Kristine Zanotti
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
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Kelkar DS, Kurlekar U, Stevens L, Wagholikar GD, Slack M. An Early Prospective Clinical Study to Evaluate the Safety and Performance of the Versius Surgical System in Robot-Assisted Cholecystectomy. Ann Surg 2023; 277:9-17. [PMID: 35170538 PMCID: PMC9762713 DOI: 10.1097/sla.0000000000005410] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the ability of the Versius Surgical System to successfully and safely complete cholecystectomy. BACKGROUND The system has been developed in-line with surgeon feedback to overcome limitations of conventional laparoscopy to enhance surgeon experience and patient outcomes. Here we present results from the cholecystectomy cohort from a completed early clinical trial, which was designed to broadly align with Stage 2b of the Idea, Development, Exploration, Assessment, Long-term follow-up framework for surgical innovation. METHODS Procedures were performed between March 2019 and September 2020 by surgical teams consisting of a lead surgeon and operating room (OR) assistants. Male or female patients aged 18 years and over and requiring cholecystectomy were enrolled. The primary endpoint was the rate of unplanned conversion from robot-assisted surgery to conventional laparoscopic or open surgery. Adverse events (AEs) and serious AEs were adjudicated by video review of the surgery and patient study reports by an independent Clinical Expert Committee. RESULTS Overall, 134/143 (93.7%) cholecystectomies were successfully completed using the device. Of the 9 (6.3%) conversions to another surgical modality, 7 were deemed to be related to the device. A total of 6 serious AEs and 3 AEs occurred in 8 patients (5.6%), resulting in 4 (2.8%) readmissions to hospital within 30 days of surgery and 1 death. CONCLUSIONS This study demonstrates cholecystectomy performed using the device is as safe and effective as conventional laparoscopy and supports the implementation of the device on a wider scale, pending instrument modifications, in alignment with Idea, Development, Exploration, Assessment, Long-term follow-up Stage 3 (Assessment).
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Affiliation(s)
- Dhananjay S Kelkar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Utkrant Kurlekar
- Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Lewis Stevens
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University London, London, UK; and
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Comparison between Laparoscopic and Robotic Approach for Sentinel Lymph Node Biopsy in Endometrial Carcinoma Women. J Pers Med 2022; 13:jpm13010029. [PMID: 36675690 PMCID: PMC9862818 DOI: 10.3390/jpm13010029] [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: 10/26/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Robotic surgery has been approved as an alternative to laparoscopy to improve surgical outcomes. There is neither a consensus nor a systematic assessment of the literature about the superiority of the robotic approach over the laparoscopic one for sentinel lymph node (SLN) biopsy in endometrial carcinoma (EC) women. Therefore, a systematic review and meta-analysis was performed to compare the laparoscopic and robotic approaches for SLN biopsy in EC patients. Five electronic databases were queried from their inception to May 2022 for peer-reviewed studies, comparing such approaches in SLN biopsy in EC patients. The rate of detected SLN, dissected SLN, intraoperative and postoperative complications, conversion to laparotomy, number of dissected SLN, and SLN identification and dissection time were compared between the laparoscopic and robotic approaches for SLN biopsy in EC patients. Odds ratios with 95% confidence intervals were calculated when possible. Two studies with 660 EC women (364 who had undergone laparoscopy, and 296 who had robotic surgery) were included. No assessed outcome showed significant differences between the two approaches. In conclusion, the laparoscopic and robotic approaches for SLN biopsy in EC patients appeared to not differ, in terms of SLN detection, intraoperative and postoperative complications, conversion to laparotomy, number of dissected SLN, and SLN identification and dissection time.
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11
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Gitas G, Hanker L, Rody A, Ackermann J, Alkatout I. Robotic surgery in gynecology: is the future already here? MINIM INVASIV THER 2022; 31:815-824. [DOI: 10.1080/13645706.2021.2010763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Luebeck, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Luebeck, Germany
| | - Johannes Ackermann
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Kiel, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Kiel, Germany
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12
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SANCAR C, YILDIRIM N, BILGI A, GOKULU S, AKMAN L, COŞAN TEREK M, AYDIN ÖZSARAN A. Endometrium kanserli obez hastalarda laparoskopik ve açık cerrahinin karşılaştırılması. EGE TIP DERGISI 2022. [DOI: 10.19161/etd.1125610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The aim of the study is to compare the results of total laparoscopic hysterectomy and total abdominal hysterectomy in obese women with endometrial cancer (EC). Materials and Methods: Patients with endometrial cancer whose BMI ≥30 kg/m2 and who were undergone total laparoscopic hysterectomy (n=68) or total abdominal hysterectomy (n=161) were included in the study. Demographic and histopathological features, disease-free survival and overall survival of the patients were recorded. All these data of laparoscopy and laparotomy patients were compared with each other.
Results: No significant difference was observed between two groups in terms of stage, tumor grade, histology, lymph node dissection rate and number of removed lymph nodes. Cardiovascular diseases were more common in laparotomy group (p=0.002). ASA (American Society of Anesthesiologists) score was higher in laparotomy group (p=0.001). Perioperative and postoperative complications were similar in both groups. The operation time was significantly longer and postoperative hospital stay was significantly shorter in the laparoscopy group (p
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Affiliation(s)
- Ceren SANCAR
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Nuri YILDIRIM
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Ahmet BILGI
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Sevki GOKULU
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Levent AKMAN
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Mustafa COŞAN TEREK
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
| | - Ahmet AYDIN ÖZSARAN
- Ege University, Faculty of Medicine, Department of Obstetrics and Gynecology, Division of Gynaecologic Oncology, Izmir, Turkiye
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13
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Robot-Assisted Minimally Invasive Breast Surgery: Recent Evidence with Comparative Clinical Outcomes. J Clin Med 2022; 11:jcm11071827. [PMID: 35407434 PMCID: PMC8999956 DOI: 10.3390/jcm11071827] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/24/2022] Open
Abstract
In recent times, robot-assisted surgery has been prominently gaining pace to minimize overall postsurgical complications with minimal traumatization, due to technical advancements in telerobotics and ergonomics. The aim of this review is to explore the efficiency of robot-assisted systems for executing breast surgeries, including microsurgeries, direct-to-implant breast reconstruction, deep inferior epigastric perforators-based surgery, latissimus dorsi breast reconstruction, and nipple-sparing mastectomy. Robot-assisted surgery systems are efficient due to 3D-based visualization, dexterity, and range of motion while executing breast surgery. The review describes the comparative efficiency of robot-assisted surgery in relation to conventional or open surgery, in terms of clinical outcomes, morbidity rates, and overall postsurgical complication rates. Potential cost-effective barriers and technical skills were also delineated as the major limitations associated with these systems in the clinical sector. Furthermore, instrument articulation of robot-assisted surgical systems (for example, da Vinci systems) can enable high accuracy and precision surgery due to its promising ability to mitigate tremors at the time of surgery, and shortened learning curve, making it more beneficial than other open surgery procedures.
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14
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Tomov ST, Gorchev GA, Kiprova DK, Lyubenov AD, Hinkova NH, Tomova VD, Gorcheva ZV, Ahmad S. Peri-operative and survival outcomes analysis of patients with endometrial cancer managed by three surgical approaches: a long-term Bulgarian experience. J Robot Surg 2022; 16:1367-1382. [PMID: 35142980 DOI: 10.1007/s11701-022-01374-0] [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: 09/28/2021] [Accepted: 01/21/2022] [Indexed: 12/24/2022]
Abstract
The study aim was to assess the peri-operative, oncologic, and survival outcomes for patients with endometrial cancer (EC) managed by abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), or robotic hysterectomy (RH) approaches at premier centers in Bulgaria. We analyzed histologically diagnosed EC cases operated via any of the three surgical methods during 2008-2019. Data analyses included patients and tumor characteristics, peri-operative outcomes, and disease status. We grouped FIGO stages I and II to represent early-stage EC and to investigate their survival. Kaplan-Meier and Cox regression analyses were performed to determine disease-free survival (DFS) and overall survival (OS). Consecutive 917 patients (AH = 466; LH = 60, RH = 391) formed the basis of study analyses. Most of demographics and tumor characteristics of the patients were comparable across the groups except few minor variations (e.g., LH/RH cases were younger, heavier, more stage IA, endometrioid, G1, low-risk group). LH and RH group cases had significantly lower operative time than AH (p < 0.001), shorter hospital length-of-stay (p < 0.001), higher post-operative Hgb (p < 0.001). RH cases had fewer blood transfusions than AH or LH (p < 0.001). Cox multivariate analyses indicate that OS was not influenced by the type of surgical approach. Despite the fact that the DFS in "early-stage" EC is significantly better in AH group than RH, the type of surgery (i.e., AH, LH, or RH) for "all stages" is insignificant factor for DFS. With our long-term experience, minimally invasive surgical approach resulted in superior peri-operative, oncologic, and survival outcomes. Specifically, RH is not only safe in terms of post-operative results, but also for mortality and oncologic rates.
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Affiliation(s)
- Slavcho T Tomov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria.
| | - Grigor A Gorchev
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Desislava K Kiprova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Aleksandar D Lyubenov
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Nadezhda H Hinkova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Vesela D Tomova
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Zornitsa V Gorcheva
- Medical University Pleven, University Hospital "Saint Marina", Pleven, 5800, Bulgaria
| | - Sarfraz Ahmad
- Gynecologic Oncology Program, AdventHealth Cancer Institute, 2501 N. Orange Ave., Suite 786, Orlando, FL, 32804, USA. .,FSU and UCF Colleges of Medicine, Orlando, FL 32804, USA.
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15
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Liu H, Cao Y, Li L, Bai Y, Liu J. Effectiveness of robotic surgery for endometrial cancer: a systematic review and meta-analysis. Arch Gynecol Obstet 2021; 305:837-850. [PMID: 34498124 DOI: 10.1007/s00404-021-06229-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND 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. PATIENTS AND METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Huafang Liu
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yanjun Cao
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Li Li
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yuqing Bai
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Jun Liu
- Department of Gynecology, Beijing Ditan Hospital, Capital Medical University, No.8 Jingshun East Street, Chaoyang District, Beijing, 100015, China.
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16
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Gokmen Karasu AF, Kıran G, Şanlıkan F. Intraoperative Complications and Conversion to Laparatomy in Gynecologic Robotic Surgery. J INVEST SURG 2021; 35:912-915. [PMID: 34286632 DOI: 10.1080/08941939.2021.1949411] [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: 10/20/2022]
Abstract
INTRODUCTION In this study our objective was to document complications encountered during our initial experience with the robotic system and also state the cases in which conversion to laparotomy was necessary. MATERIAL AND METHODS This study is a retrospective analysis of robotically performed gynecological and gynecologic oncology procedures at a single center from July 2016 to July 2018. Patient demographics and preoperative indications were obtained from the electronic medical records. RESULTS The patients had a mean age of 53.6 years (range, 25-84 years). The operative time ranged from 1 h and 50 min to 9 h (mean, 5 h and 2 min). Most of the complications were managed within minutes and with robotic assisted suturing when necessary. Five patients out of 83 patients needed a surgical conversion from robotic surgery. Conversion rate was 6.02%. CONCLUSION During the study period we were able to manage complications uneventfully without requiring conversion to laparotomy most of the time. Vascular complications encountered during robotic surgery can be managed without requiring conversion to laparatomy.
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Affiliation(s)
- Ayse Filiz Gokmen Karasu
- Medical Faculty, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Gürkan Kıran
- Medical Faculty, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fatih Şanlıkan
- Department of Obstetrics and Gynecology, Umraniye Research and Training Hospital, Memorial Sisli Hospital, Istanbul, Turkey
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17
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King LJ, Young AJ, Nagar PM, McDowell JL, Smith AL. Outcomes of robotic surgery in morbidly obese patients with endometrial cancer: a retrospective study. J Robot Surg 2021; 16:569-573. [PMID: 34278543 DOI: 10.1007/s11701-021-01277-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
With advances in minimal invasive surgery, robotic surgery has become the widespread approach for surgical staging of endometrial cancer in the obese population. This study aimed to evaluate safety and surgical outcomes of robotic surgery in the morbidly obese and extremely morbidly obese patients with endometrial cancer. Retrospective cohort study. A total of 391 obese women undergoing robotic-assisted surgical staging were identified and included in the study. Surgical outcomes for obese patients (BMI > 30 kg/m2) who underwent surgical staging between 2011 and 2019 were retrospectively collected. Preoperative characteristics, perioperative outcomes and postoperative complications were analyzed among the categories of obesity (BMI ≥ 30-34.9 kg/m2, ≥ 35-39.9 kg/m2, ≥ 40-49.9 kg/m2) including the extremely morbid obese (BMI > 50 kg/m2). Comparative analysis revealed a higher percentage of postoperative complications with increasing BMI, although the results were not statistically significant. Postoperative complications are observed at higher rates among women with increasing BMI.
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Affiliation(s)
- Luke J King
- Women's Health, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, USA
| | - Amanda J Young
- Biostatistics Core, Department of Population Health Sciences, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, USA
| | - Preeyanka M Nagar
- Women's Health, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, USA
| | - Jamie L McDowell
- Women's Health, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, USA.
| | - Ashlee L Smith
- Women's Health, Geisinger Medical Center, 100 N Academy Ave, Danville, 17822, USA.,Gynecologic Oncology, Rochester Regional Health, 1415 Portland Ave, Rochester, 14621, USA
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18
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Gitas G, Alkatout I, Proppe L, Werner N, Rody A, Hanker L, Pados G, Freytag D, Sommer S, Baum S. Surgical outcomes of conventional laparoscopic and robotic-assisted hysterectomy. Int J Med Robot 2021; 17:e2225. [PMID: 33440062 DOI: 10.1002/rcs.2225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the present study was to compare surgical outcomes of total laparoscopic hysterectomy with those of the robotic approach using the da Vinci Xi system. METHODS Patients who underwent hysterectomy with da Vinci Xi for early endometrial cancer or benign indications from 2018 to 2019 were selected. The control group consisted of patients who underwent conventional laparoscopy. RESULTS A total of 300 patients were included in the study. The mean duration of surgery differed significantly (p = 0.025) between those who underwent laparoscopy (125.01 ± 76.168) and robotic-assisted surgery (142.96 ± 82.657 min). Blood loss, median hospital stay, intraoperative and postoperative complications were similar in both groups. No statistical difference was observed in the subgroups with a body mass index of more than 30 kg/m2 or more than 40 kg/m2 concerning the duration of surgery or the surgical outcome. CONCLUSION The da Vinci Xi did not improve surgical outcomes in patients who underwent hysterectomy by trained laparoscopists and takes more time than conventional laparoscopy when performed in patients of normal weight.
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Affiliation(s)
- Georgios Gitas
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Louisa Proppe
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Nele Werner
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Lars Hanker
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - George Pados
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Kiel, Kiel, Germany
| | - Soteris Sommer
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
| | - Sascha Baum
- Department of Obstetrics and Gynecology, University Hospital of Schleswig Holstein, Campus Luebeck, Luebeck, Germany
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Eoh KJ, Lee DW, Lee JH, Nam EJ, Kim SW, Kim YT. Comparative Survival Outcome of Robot-Assisted Staging Surgery Using Three Robotic Arms versus Open Surgery for Endometrial Cancer. Yonsei Med J 2021; 62:68-74. [PMID: 33381936 PMCID: PMC7820443 DOI: 10.3349/ymj.2021.62.1.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE There is lack of data on direct comparison of survival outcomes between open surgery and robot-assisted staging surgery (RSS) using three robotic arms for endometrial cancer. The purpose of this study was to compare the overall survival (OS) and disease-free survival (DFS) between open surgery and RSS using three robotic arms for endometrial cancer. MATERIALS AND METHODS Consecutive women with endometrial cancer who underwent surgery between May 2006 and May 2018 were identified. Robotic procedures were performed using the da Vinci robotic system, and the robotic approach consisted of three robotic arms including a camera arm. Propensity score matching, as well as univariate and multivariate Cox regression of OS and DFS were performed according to clinicopathologic data and surgical method. RESULTS The study cohort included 423 unselected patients with endometrial cancer, of whom 218 underwent open surgery and 205 underwent RSS using three robotic arms. Propensity score-matched cohorts of 146 women in each surgical group showed no significant differences in survival: 5-year OS of 91% vs. 92% and DFS of 86% vs. 89% in the open and robotic cohorts, respectively (hazard ratio, 1.02; 95% confidence interval, 0.82-1.67). In the univariate analysis with OS as the endpoint, surgical method, age, stage, type II histology, grade, and lymph node metastasis were independently associated with survival. Surgical stage, grade, and type II histology were found to be significant independent predictors for OS in the multivariate analysis. CONCLUSION RSS using three robotic arms and laparotomy for endometrial carcinoma had comparable survival outcomes.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Woo Lee
- Department of Obstetrics and Gynecology, Bucheon St. Mary's Hospital, the Catholic University College of Medicine, Bucheon, Korea
| | - Ji Hyun Lee
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Ji Nam
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Wun Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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20
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Perrone E, Capasso I, Pasciuto T, Gioè A, Gueli Alletti S, Restaino S, Scambia G, Fanfani F. Laparoscopic vs. robotic-assisted laparoscopy in endometrial cancer staging: large retrospective single-institution study. J Gynecol Oncol 2021; 32:e45. [PMID: 33825360 PMCID: PMC8039171 DOI: 10.3802/jgo.2021.32.e45] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/09/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The aim of this study is to analyze and draw the potential differences between the robotic-assisted surgery (RS) and the laparoscopy (LPS) in endometrial cancer staging. Methods In this single-institution retrospective study we enrolled 1,221 consecutive clinical stage I–III endometrial cancer patients undergone minimally invasive surgical staging. We compared patients treated by LPS and by RS, on the basis of perioperative and oncological outcomes (disease-free survival [DFS] and overall survival [OS]). A sub-analysis of the high-risk endometrial cancer population was performed in the 2 cohorts. Results The 2 cohorts (766 treated by LPS and 455 by RS) were homogeneous in terms of perioperative and pathological data. We recorded differences in number of relapse/progression (11.7% in LPS vs. 7% in RS, p=0.008) and in number of deaths (9.8% in LPS vs. 4.8% in RS, p=0.002). Whereas, univariate and multivariate analyses according to DFS and OS confirmed that the surgical approach did not influence the DFS or the OS. In the multivariable analysis the association of the age and grading was significant for DFS and OS. In the sub-analysis of the 426 high risk EC patients (280 in LPS and 146 in RS) the univariate and the multivariate confirmed the influence of the age in DFS and OS, independently of the minimally invasive approach. Conclusions In our large retrospective analysis, we confirmed that the RS and LPS have similar efficacy and safety for endometrial cancer staging also for the high-risk endometrial cancer patients.
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Affiliation(s)
- Emanuele Perrone
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Ilaria Capasso
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Tina Pasciuto
- Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Rome, Italy
| | - Alessandro Gioè
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Salvatore Gueli Alletti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Stefano Restaino
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Roma, Italy.,Università Cattolica del Sacro Cuore, Roma, Italy.
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Sofer A, Magnezi R, Eitan R, Raban O, Tal O, Smorgic N, Vaknin Z. Robotic vs. open surgery in obese women with low-grade endometrial cancer: comparison of costs and quality of life measures. Isr J Health Policy Res 2020; 9:60. [PMID: 33138857 PMCID: PMC7607708 DOI: 10.1186/s13584-020-00412-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 10/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background This 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. Methods Obese 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. Results In 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). Conclusions Obese 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.
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Affiliation(s)
- Adi Sofer
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Racheli Magnezi
- Department of Management, Bar Ilan University, Ramat Gan, Israel
| | - Ram Eitan
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Raban
- Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center-Beilinson Hospital, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orna Tal
- Department of Management, Bar Ilan University, Ramat Gan, Israel.,Yitzhak Shamir (formerly Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Noam Smorgic
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofeh) Medical Center, 70300, Zerifin, Israel
| | - Zvi Vaknin
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Obstetrics and Gynecology, Yitzhak Shamir (formerly Assaf Harofeh) Medical Center, 70300, Zerifin, Israel.
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Kakkos A, Ver Eecke C, Ongaro S, Traen K, Peeters F, Van Trappen P, Laenen A, Despierre E, Van Nieuwenhuysen E, Vergote I, Goffin F. Robot-assisted surgery for women with endometrial cancer: Surgical and oncologic outcomes within a Belgium gynaecological oncology group cohort. Eur J Surg Oncol 2020; 47:1117-1123. [PMID: 33268212 DOI: 10.1016/j.ejso.2020.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To evaluate surgical and oncologic outcomes of patients treated by robot-assisted surgery for endometrial cancer within the Belgium Gynaecological Oncology Group (BGOG). STUDY DESIGN We performed a retrospective analysis of women with clinically Stage I endometrial cancer who underwent surgical treatment from 2007 to 2018 in five institutions of the BGOG group. RESULTS A total of 598 consecutive women were identified. The rate of conversion to laparotomy was low (0.8%). The mean postoperative Complication Common Comprehensive Index (CCI) score was 3.4. The rate of perioperative complications did not differ between age groups, however the disease-free survival was significantly lower in patients over 75 years compared to patients under 65 years of age (p=0.008). Per-operative complications, conversion to laparotomy rate, post-operative hospital stay, CCI score and disease-free survival were not impacted by increasing BMI. CONCLUSION Robot-assisted surgery for the surgical treatment of patients suffering from early-stage endometrial cancer is associated with favourable surgical and oncologic outcomes, particularly for unfavourable groups such as elderly and obese women, thus permitting a low morbidity minimally-invasive surgical approach for the majority of patients in expert centres.
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Affiliation(s)
- A Kakkos
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium.
| | - C Ver Eecke
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - S Ongaro
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium
| | - K Traen
- Department of Obstetrics and Gynaecology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - F Peeters
- Department of Obstetrics and Gynaecology, General Hospital Klina, Brasschaat, Belgium
| | - Ph Van Trappen
- Department of Obstetrics and Gynaecology, General Hospital Sint-Jan, Bruges, Belgium
| | - A Laenen
- Department of Biostatistics and Methodology, Catholic University of Leuven, Leuven, Belgium
| | - E Despierre
- Department of Obstetrics and Gynaecology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - E Van Nieuwenhuysen
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - I Vergote
- Division of Gynaecological Oncology, Department of Obstetrics and Gynaecology, Leuven Cancer Institute, Catholic University of Leuven, Leuven, Belgium
| | - F Goffin
- Department of Obstetrics and Gynaecology, Centre Hospitalier Universitaire de Liège, Site Notre Dame des Bruyères et Centre Hospitalier Régional, Liège, Belgium
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Johansson CYM, Chan FKH. Robotic-assisted versus conventional laparoscopic hysterectomy for endometrial cancer. Eur J Obstet Gynecol Reprod Biol X 2020; 8:100116. [PMID: 32995747 PMCID: PMC7508988 DOI: 10.1016/j.eurox.2020.100116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 08/27/2020] [Accepted: 09/04/2020] [Indexed: 11/20/2022] Open
Abstract
Objective The safety and efficacy of robotic-assisted laparoscopic hysterectomy (RALH) compared with conventional total laparoscopic hysterectomy (TLH) for surgical staging of endometrial cancer has not been clearly established. With the commencement of a robotic program at our institution, our objective was to evaluate and compare the surgical outcomes of RALH with TLH for endometrial cancer. Methods A retrospective cohort study was performed on 39 patients who underwent RALH and 41 patients who underwent TLH for endometrial cancer at a tertiary care academic institution. Results In the setting of endometrial cancer RALH is significantly longer to perform than TLH (mean operating time 133 min vs 107 min, p = 0.0001). There is higher estimated blood loss in TLH cases than RALH cases (78 mL vs 22 mL, p = 0.015). Women who underwent RALH had a shorter length of stay (1.3 days vs 1.8 days, p = 0.006) than TLH patients, and six cases (15 %) of the RALH group were discharged on the same day of surgery. There were no differences between the RALH and TLH groups in intraoperative or postoperative complications and there were no conversions to laparotomy. Conclusion RALH is safe and feasible for the treatment of endometrial cancer, with low morbidity, less blood loss and shorter length of stay than TLH. RALH is associated with longer mean operating times than TLH and this may improve with enlisting a consistent experienced team. Prospective randomised studies which include analysis of quality of life measures and long-term outcomes are required to further establish the role of RALH in the surgical staging of endometrial cancer.
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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: 7] [Impact Index Per Article: 1.8] [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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Lavoue V, Collinet P, Fernandez H. Robotic surgery in gynecology: Has France lost its leadership in minimally invasive surgery? J Gynecol Obstet Hum Reprod 2020; 49:101708. [PMID: 32044338 DOI: 10.1016/j.jogoh.2020.101708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Vincent Lavoue
- CHU Rennes, Service Gynécologie Obstétrique, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - Pierre Collinet
- CHU Lille, Service Gynécologie Obstétrique, rue Eugène Avinée, 59037, Lille, France
| | - Hervé Fernandez
- AP-HP, GHU-Sud, CHU Bicêtre, Service Gynécologie Obstétrique, 78 rue du Général Leclerc, 94270, Le Kremlin Bicêtre, France; Faculté de Médecine Paris-Sud Saclay, 63 rue Gabriel Péri, 94270, Le Kremlin Bicêtre, France; Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France.
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A Meta-Analysis of Robotic Surgery in Endometrial Cancer: Comparison with Laparoscopy and Laparotomy. DISEASE MARKERS 2020; 2020:2503753. [PMID: 32454902 PMCID: PMC7212337 DOI: 10.1155/2020/2503753] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 10/23/2019] [Indexed: 12/26/2022]
Abstract
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.
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Robotic surgery in obese patients with early-stage endometrial cancer. Wideochir Inne Tech Maloinwazyjne 2019; 15:171-175. [PMID: 32117501 PMCID: PMC7020708 DOI: 10.5114/wiitm.2019.89337] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/06/2019] [Indexed: 01/08/2023] Open
Abstract
Aim The objective of this study was to assess the clinical effectiveness of robotic surgery for obese patients (body mass index (BMI) ≥ 30 kg/m2) with early stage endometrial cancer. Material and methods This study is a retrospective review of women who underwent robotic surgery for early-stage endometrial cancer from 2008 to 2017. Patients were subdivided into those with BMI < 30 kg/m2 (group 1), and those with BMI ≥ 30 kg/m2 (group 2). Basic demographics and perioperative period outcomes were extracted from the medical records and compared. Results Group 1 included fifty patients and group 2 included 24 patients. There were no significant differences in surgical outcomes or complication rates between the two groups (p > 0.05 for all). There were no differences in pelvic nodal counts or length of stay. Conclusions Robotic surgery was found to be feasible and safe for obese patients with endometrial cancer. Its widespread application needs a larger sample with longer follow-up.
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Nayyar N, Sekhon RK, Jain V, Naithani A, Rawal SK. Clinical Outcomes of Robotic Versus Open Radical Hysterectomy in Endometrial Cancer Staging: An Experience at a Tertiary Referral Care Center. J Gynecol Surg 2019. [DOI: 10.1089/gyn.2019.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nidhi Nayyar
- BLK Cancer Centre, BLK Super Specialty Hospital, Delhi, India
| | - Rupinder K. Sekhon
- Department of Uro-Gynae Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Vandana Jain
- Department of Uro-Gynae Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Amita Naithani
- Department of Uro-Gynae Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sudhir K. Rawal
- Department of Uro-Gynae Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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Does surgical platform impact recurrence and survival? A study of utilization of multiport, single-port, and robotic-assisted laparoscopy in endometrial cancer surgery. Am J Obstet Gynecol 2019; 221:243.e1-243.e11. [PMID: 31075245 DOI: 10.1016/j.ajog.2019.04.038] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/26/2019] [Accepted: 04/30/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimally invasive hysterectomy is the standard of care in the majority of women diagnosed with endometrial cancer via robotic-assisted, multiport, and single-port laparoscopy technology. Although safe and efficacious, it is unclear how oncologic outcomes are impacted by surgical platform. OBJECTIVE To identify differences in progression-free survival and overall survival in women undergoing minimally invasive surgery for endometrial cancer staging via either multiport, single-port, or robotic-assisted laparoscopy. STUDY DESIGN A multicenter, single-institution retrospective cohort study was performed in women with a diagnosis of endometrial cancer who underwent minimally invasive surgery from 2009 to 2015. Data were collected for demographics, pathologic information, adjuvant treatment, and disease status. Pearson χ2 and Fisher exact tests were used to evaluate risk factors for outcomes, Kaplan-Meier estimates and Cox proportional hazards were used to evaluate differences in time to progression or death, and multivariate regression analysis was performed. RESULTS In total, 1150 women with endometrial cancer underwent robotic-assisted laparoscopy (n=652), multiport laparoscopy (n=214), or single-port laparoscopy (n=284). The median age and body mass index of women was 62.0 years and 33.5 kg/m2, respectively. The majority of patients had endometrioid histology (88.1%), stage IA (74.7%) or IB disease (13.1%) and International Federation of Gynecology and Obstetrics grade 1 (57.4%) or 2 (26.0%) histology. Lymphovascular space invasion was present in 24.7% (n=283). Adjuvant radiation was given in 34.2% of cases, with 21.9% receiving vaginal brachytherapy, 6.6% pelvic radiation, and 5.4% both. For the entire cohort, there were no differences in progression-free survival at 2, 3, and 5 years for multiport laparoscopy (94.2%, 91.4%, 87.4%), robotic-assisted laparoscopy (94.5%, 92.9%, 88.8%), and single-port laparoscopy (93.6%, 91.2%, 90.0%) (P=.93), respectively. Similarly, there were no differences in overall survival at 2, 3, and 5 years for multiport laparoscopy (94.4%, 91.8%, 91.8%), robotic-assisted laparoscopy (95.6%, 93.4%, 90.7%), and single-port laparoscopy (95.0, 93.1, 91.8) (P=.99), respectively. Among women with stage IA and IB disease, no difference existed for progression-free survival at 2, 3, and 5 years for multiport laparoscopy (94.2%, 91.4%, 87.4%), robotic-assisted laparoscopy (94.5%, 92.9%, 88.8%), and single-port laparoscopy (93.6, 91.2, 90.0) (P=.93), respectively. Similarly, among women with stage I disease, there was no difference in overall survival at 2, 3, and 5 years for multiport laparoscopy (96.2%, 95.0%, 95.0%), robotic-assisted laparoscopy (96.6%, 95.4%, 93.3%), and single-port laparoscopy (96.6%, 95.0%, 93.4%) (P=.89). Rather, progression-free survival and overall survival were predicted by age >65 years, stage, grade, and histology (P<.05). On multivariate analysis, modality of surgery did not impact overall survival or progression-free survival (robotic-assisted laparoscopy, hazard ratio, 1.28, P=.50; single-port laparoscopy, hazard ratio, 0.84, P=.68 vs multiport laparoscopy). Age >65 years (hazard ratio, 5.42, P<.001) and advanced stage disease (P=.003) were associated with decreased overall survival. CONCLUSION In this retrospective cohort, there was no difference in progression-free survival or overall survival in women undergoing surgery for endometrial cancer via robotic-assisted laparoscopy, single-port laparoscopy, or multiport laparoscopy.
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Wang LL, Yan PJ, Yao L, Liu R, Hou F, Chen XH, Han LL, Xu LY, Xu H, Li J, Guo TK, Yang KH, Wang HL. Evaluation of intra- and post-operative outcomes to compare robot-assisted surgery and conventional laparoscopy for gynecologic oncology. Asian J Surg 2019; 43:347-353. [PMID: 31229360 DOI: 10.1016/j.asjsur.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To compare robot-assisted surgery and conventional laparoscopy for gynecologic oncology regarding intra- and post-operative outcomes. METHODS A retrospective study was performed on consecutive patients with gynecologic oncology from February 2014 to October 2017 at Gansu Provincial Hospital, China. Multivariable linear and logistic regression models were performed to explore the difference between two surgeries in the surgical outcomes after adjusting for potential confounders. RESULTS 276 women were included in this study: 153 robot-assisted surgeries and 123 conventional laparoscopies. The multivariable linear regression model showed that robot-assisted surgery was longer operative time [coefficient (coef), 33.76; 95% CI, 12.47, 55.05; P = 0.002) ], higher lymph node yield (coef, 10.41; 95% CI, 7.47, 13.35; P < 0.001), shorter time to early post-operative feeding (coef, -1.09; 95% CI, -1.33, -0.84; P < 0.001) and less post-operative drainage volume (coef, -368.77; 95% CI, -542.46, -195.09; P < 0.001) than conventional laparoscopy. However, no difference was observed between the two surgeries regarding the estimated blood loss (P > 0.05). The multivariable logistic regression model showed that post-operative complications were similar between robot-assisted surgery and conventional laparoscopy (P > 0.05). CONCLUSION Robot-assisted surgery was superior to conventional laparoscopy regarding intra- and post-operative outcomes for gynecologic oncology.
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Affiliation(s)
- Liu-Li Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, PR China; Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou 730000, PR China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China; Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Pei-Jing Yan
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Rong Liu
- The Second Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, PR China
| | - Fan Hou
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, PR China; Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Xiao-Hong Chen
- Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Liang-Liang Han
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, PR China
| | - Li-Yuan Xu
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, PR China; Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou 730000, PR China
| | - Hui Xu
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Jing Li
- School of Public Health, Lanzhou University, Lanzhou, 730000, PR China
| | - Tian-Kang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, PR China.
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, PR China; Institution of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou 730000, PR China; Key laboratory of Evidence-Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, PR China.
| | - Hai-Lin Wang
- The First Clinical Medical College of Lanzhou University, Lanzhou 730000, PR China; Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou 730000, PR China.
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Abstract
BACKGROUND This is an updated merged review of two originally separate Cochrane reviews: one on robot-assisted surgery (RAS) for benign gynaecological disease, the other on RAS for gynaecological cancer. RAS is a relatively new innovation in laparoscopic surgery that enables the surgeon to conduct the operation from a computer console, situated away from the surgical table. RAS is already widely used in the United States for hysterectomy and has been shown to be feasible for other gynaecological procedures. However, the clinical effectiveness and safety of RAS compared with conventional laparoscopic surgery (CLS) have not been clearly established and require independent review. OBJECTIVES To assess the effectiveness and safety of RAS in the treatment of women with benign and malignant gynaecological disease. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, and EMBASE via Ovid, on 8 January 2018. We searched www.ClinicalTrials.gov. on 16 January 2018. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing RAS versus CLS or open surgery in women requiring surgery for gynaecological disease. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and risk of bias, and extracted study data and entered them into an Excel spreadsheet. We examined different procedures in separate comparisons and for hysterectomy subgrouped data according to type of disease (non-malignant versus malignant). When more than one study contributed data, we pooled data using random-effects methods in RevMan 5.3. MAIN RESULTS We included 12 RCTs involving 1016 women. Studies were at moderate to high overall risk of bias, and we downgraded evidence mainly due to concerns about risk of bias in the studies contributing data and imprecision of effect estimates. Procedures performed were hysterectomy (eight studies) and sacrocolpopexy (three studies). In addition, one trial examined surgical treatment for endometriosis, which included resection or hysterectomy. Among studies of women undergoing hysterectomy procedures, two studies involved malignant disease (endometrial cancer); the rest involved non-malignant disease.• RAS versus CLS (hysterectomy)Low-certainty evidence suggests there might be little or no difference in any complication rates between RAS and CLS (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.54 to 1.59; participants = 585; studies = 6; I² = 51%), intraoperative complication rates (RR 0.77, 95% CI 0.24 to 2.50; participants = 583; studies = 6; I² = 37%), postoperative complications (RR 0.81, 95% CI 0.48 to 1.34; participants = 629; studies = 6; I² = 44%), and blood transfusions (RR 1.94, 95% CI 0.63 to 5.94; participants = 442; studies = 5; I² = 0%). There was no statistical difference between malignant and non-malignant disease subgroups with regard to complication rates. Only one study reported death within 30 days and no deaths occurred (very low-certainty evidence). Researchers reported no survival outcomes.Mean total operating time was longer on average in the RAS arm than in the CLS arm (mean difference (MD) 41.18 minutes, 95% CI -6.17 to 88.53; participants = 148; studies = 2; I² = 80%; very low-certainty evidence), and the mean length of hospital stay was slightly shorter with RAS than with CLS (MD -0.30 days, 95% CI -0.53 to -0.07; participants = 192; studies = 2; I² = 0%; very low-certainty evidence).• RAS versus CLS (sacrocolpopexy)Very low-certainty evidence suggests little or no difference in rates of any complications between women undergoing sacrocolpopexy by RAS or CLS (RR 0.95, 95% CI 0.21 to 4.24; participants = 186; studies = 3; I² = 78%), nor in intraoperative complications (RR 0.82, 95% CI 0.09 to 7.59; participants = 108; studies = 2; I² = 47%). Low-certainty evidence on postoperative complications suggests these might be higher with RAS (RR 3.54, 95% CI 1.31 to 9.56; studies = 1; participants = 68). Researchers did not report blood transfusions and deaths up to 30 days.Low-certainty evidence suggests that RAS might be associated with increased operating time (MD 40.53 min, 95% CI 12.06 to 68.99; participants = 186; studies = 3; I² = 73%). Very low-certainty evidence suggests little or no difference between the two techniques in terms of duration of stay (MD 0.26 days, 95% CI -0.15 to 0.67; participants = 108; studies = 2; I² = 0%).• RAS versus open abdominal surgery (hysterectomy)A single study with a total sample size of 20 women was included in this comparison. For most outcomes, the sample size was insufficient to show any possible differences between groups.• RAS versus CLS for endometriosisA single study with data for 73 women was included in this comparison; women with endometriosis underwent procedures ranging from relatively minor endometrial resection through hysterectomy; many of the women included in this study had undergone previous surgery for their condition. For most outcomes, event rates were low, and the sample size was insufficient to detect potential differences between groups. AUTHORS' CONCLUSIONS Evidence on the effectiveness and safety of RAS compared with CLS for non-malignant disease (hysterectomy and sacrocolpopexy) is of low certainty but suggests that surgical complication rates might be comparable. Evidence on the effectiveness and safety of RAS compared with CLS or open surgery for malignant disease is more uncertain because survival data are lacking. RAS is an operator-dependent expensive technology; therefore evaluating the safety of this technology independently will present challenges.
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Affiliation(s)
- Theresa A Lawrie
- Office 305, 3rd floorE‐MBC LtdNorthgate HouseUpper Borough WallsBathUKBA1 1RG
| | - Hongqian Liu
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - DongHao Lu
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
| | - Therese Dowswell
- The University of LiverpoolC/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Huan Song
- University of IcelandCenter of Public Health Sciences, Faculty of MedicineReykjavíkIceland
| | - Lei Wang
- West China Second University Hospital, Sichuan UniversityDepartment of OrthopedicsNo. 37, Guo Xue XiangChengduSichuanChina610041
| | - Gang Shi
- West China Second University Hospital, Sichuan UniversityDepartment of Obstetrics and GynecologyNo. 17, Section Three, Ren Min Nan Lu AvenueChengduSichuanChina610041
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Robotic-Assisted Infrarenal Para-aortic Lymphadenectomy in Gynecological Cancers: Technique and Surgical Outcomes. Int J Gynecol Cancer 2019; 28:951-958. [PMID: 29683877 DOI: 10.1097/igc.0000000000001249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Mini-invasive surgery has essentially replaced open laparotomy in surgery for endometrial and cervical carcinoma. Of the procedures needed for a complete staging, especially para-aortic lymphadenectomy (PALND) is challenging to perform. The present study was undertaken to investigate the technical and surgical outcomes of robotic-assisted PALND for gynecological cancers in the setting of a tertiary university hospital in Finland. METHODS This was a retrospective chart review of 283 robotic-assisted para-aortic lymphadenectomies using the single-docking transperitoneal technique performed at the Department of Obstetrics and Gynecology of Tampere University Hospital, in 2009-2016. The primary outcome measure was the extent of the operation in terms of the height, that is, how often the level cranial to the inferior mesenteric artery (IMA) was achieved. The secondary outcome measures included operation time and surgical outcome. RESULTS The majority of operations (n = 239 [84.4%]) were performed for endometrial carcinoma. The most common operation type was robotic-assisted hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy and PALND, which took a median of 3:38 hours or 218 minutes (range, 140-341 minutes) to perform. The high PALND (above the level of IMA) succeeded in 235 operations (83%). In the total cohort, the median number of para-aortic lymph nodes removed was 12 (range, 0-38), with a learning curve approximately more than 40 operations. Para-aortic lymph node metastases were found in 43 patients (15.2%). Seven conversions to laparotomy (2.5%) were done. The conversion and intraoperative complication rates were 2.5% and 3.5%, respectively, and postoperative complications was 18%, according to the classification of Clavien-Dindo. The median length of the postoperative hospital stay was 2 days (range, 1-8 days). CONCLUSIONS Using the transperitoneal technique for PALND, the area between IMA and the renal veins can be reached in more than 80% of the operations, with a very low or 2.5% conversion rate.
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Connelly TM, Malik Z, Sehgal R, Byrnes G, Coffey JC, Peirce C. The 100 most influential manuscripts in robotic surgery: a bibliometric analysis. J Robot Surg 2019; 14:155-165. [PMID: 30949890 DOI: 10.1007/s11701-019-00956-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 03/28/2019] [Indexed: 01/18/2023]
Abstract
Since the first robotic assisted surgery in 1985, the number of procedures performed annually has steadily increased. Bibliometric analysis highlights the key studies that have influenced current practice in a field of interest. We use bibliometric analysis to evaluate the 100 most cited manuscripts on robotic surgery and discuss their content and influence on the evolution of the platform. The terms 'robotic surgery,' 'robot assisted surgery' and 'robot-assisted surgery' were used to search Thomson Reuters Web of Science database for full length, English language manuscripts. The top 100 cited manuscripts were analyzed by manuscript type, surgical specialty, first and last author, institution, year and journal of publication. 14,980 manuscripts were returned. Within the top 100 cited manuscripts, the majority featured urological surgery (n = 28), followed by combined results from multiple surgical subspecialties (n = 15) and colorectal surgery (n = 13). The majority of manuscripts featured case series/reports (n = 42), followed by comparative studies (n = 24). The most cited paper authored by Nelson et al. (432 citations) reviewed technological advances in the field. The year and country with the greatest number of publications were 2009 (n = 15) and the USA (n = 68). The Johns Hopkins University published the most top 100 manuscripts (n = 18). The 100 most cited manuscripts reflect the progression of robotic surgery from a basic instrument-holding platform to today's articulated instruments with 3D technology. From feasibility studies to multicenter trials, this analysis demonstrates how robotic assisted surgery has gained acceptance in urological, colorectal, general, cardiothoracic, orthopedic, maxillofacial and neuro surgery.
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Affiliation(s)
- Tara M Connelly
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland.
| | - Zoya Malik
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rishabh Sehgal
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Gerrard Byrnes
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - J Calvin Coffey
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Colorectal Surgery, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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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: 10] [Impact Index Per Article: 1.7] [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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Corrado G, Vizza E, Cela V, Mereu L, Bogliolo S, Legge F, Ciccarone F, Mancini E, Gallotta V, Baiocco E, Monterossi G, Perri MT, Zampa A, Pasciuto T, Scambia G. Laparoscopic versus robotic hysterectomy in obese and extremely obese patients with endometrial cancer: A multi-institutional analysis. Eur J Surg Oncol 2018; 44:1935-1941. [DOI: 10.1016/j.ejso.2018.08.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
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Planque H, Martin-Françoise S, Lequesne J, Le Brun JF. [Robotic surgery in endometrial cancer: Feasibility in obese patients]. ACTA ACUST UNITED AC 2018; 46:625-631. [PMID: 30115552 DOI: 10.1016/j.gofs.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Minimally invasive surgery is a technique frequently used in gynecologic surgery. The robot-assisted surgery is a recent approach, and the benefits are not yet proven. The objective of this study was to evaluate the feasibility to use robot-assisted surgery for obese patient with endometrial cancer. METHODS All patients undergoing a robotic surgery for uterus malignant indication between March 2013 and May 2016 in our center were retrospectively included. Patients were divided in two groups, according to their body mass index (BMI). The group with BMI<30kg/m2 was the reference for this comparative study. The main criteria was the robot operative time. The other criteria were total operating time, hospital stay and intraoperative and postoperative complications. RESULTS Seventy-seven patients met inclusion criteria for analysis. The median robot operative time was 110minutes for all patients [21-341], without difference between the five groups (P=0.60). There was no difference for the total operative time (P=0.50). The median hospital stay was 3 days (P=0.92). There were ten intraoperative complications. One patient had a conversion (1.3%). There was no statistical difference for postoperative complications (P=1). CONCLUSION Our study found few differences in the surgical management by laparoscopic robot-assisted between obese and non obese women. Robot-assisted surgery seems to be feasible for uterine cancer treatment of obese patients. Prospective and randomized studies are needed to assess the benefit of the robotic surgery.
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Affiliation(s)
- H Planque
- Service de chirurgie cancérologique, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
| | - S Martin-Françoise
- Service de chirurgie cancérologique, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
| | - J Lequesne
- Service de recherche clinique, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
| | - J F Le Brun
- Service de chirurgie cancérologique, centre de lutte contre le cancer François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France.
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Picard F, Deakin A, Balasubramanian N, Gregori A. Minimally invasive total knee replacement: techniques and results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2018; 28:781-791. [PMID: 29564615 PMCID: PMC6003981 DOI: 10.1007/s00590-018-2164-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Accepted: 02/18/2018] [Indexed: 02/07/2023]
Abstract
In this review, we outlined the definition of minimally invasive surgery (MIS) in total knee replacement (TKR) and described the different surgical approaches reported in the literature. Afterwards, we went through the most recent studies assessing MIS TKR. Next, we searched for potential limitations of MIS knee replacement and tried to answer the following questions: Are there selective criteria and specific patient selection for MIS knee surgery? If there are, then what are they? After all, a discussion and conclusion completed this article. There is certainly room for MIS or at least less invasive surgery for appropriate selected patients. Nonetheless, there are differences between approaches. Mini-medial parapatellar is easy to master, quick to perform and potentially extendable, whereas mini-subvastus and mini-midvastus are trickier and require more caution related to risk of haematoma and vastus medialis oblique (VMO) nerve damage. Current evidence on the safety and efficacy of mini-incision surgery for TKR does not appear fully adequate for the procedure to be used without special arrangements for consent and for audit or continuing research. There is an argument that a sudden jump from standard TKR to MIS TKR, especially without computer assistance such as navigation, patient-specific instrumentation or robotic, may breach a surgeon's duty of care towards patients because it exposes patients to unnecessary risks. As a final point, more evidence is required on the long-term safety and efficacy of this procedure which will give objective shed light on real benefits of MIS TKR.
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Affiliation(s)
- Frederic Picard
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK.
- Biomedical Engineering, Strathclyde University, Glasgow, UK.
| | - Angela Deakin
- Biomedical Engineering, Strathclyde University, Glasgow, UK
- Surgiconcept Ltd, Glasgow, UK
| | | | - Alberto Gregori
- Golden Jubilee National Hospital, Agamemnon Street, Clydebank, G81 4DY, UK
- Hairmyres Hospital, Eaglesham East Kilbride, Glasgow, G758RG, UK
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The Feasibility of Laparoscopic Surgery in Gynecologic Oncology for Obese and Morbidly Obese Patients. Int J Gynecol Cancer 2018; 28:967-974. [DOI: 10.1097/igc.0000000000001260] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BackgroundSurgical interventions are the mainstay of treatment for many gynecological cancers. Although minimally invasive surgery offers many potential advantages, performing laparoscopic pelvic surgery in obese patients remains challenging. To overcome this, many centers have shifted their practice to robotic surgery; however, the high costs associated with robotic surgery are concerning and limit its use.ObjectiveThis study aimed to examine the feasibility of performing laparoscopic gynecologic oncology procedures in obese and morbidly obese patients.Materials and MethodsThis retrospective study evaluated patients who underwent laparoscopic surgeries by a gynecologic oncologist from January 2012 to June 2016 at a designated gynecologic oncology center. Patients were categorized as nonobese (body mass index [BMI] < 30 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ≥ 40 kg/m2). Intra and postoperative complications and outcomes were recorded. Group differences were computed with Kruskal-Wallis nonparametric test (continuous) or Fisher exact test (categorical).ResultsOf 497 patients, 288 were nonobese (58%), 162 obese (33%), and 47 morbidly obese (9%). Complex surgical procedures were performed in 57.4% of obese patients and 55.3% of morbidly obese patients. Although morbidly obese and obese patients had longer operative times (mean of 181 and 166 minutes vs 144 minutes,P= 0.014), conversion from laparoscopy to laparotomy occurred in 9.05% of all patients, with no group differences. Low intraoperative (9%–11%) and severe postoperative (2.41%) complication rates were observed overall, with no group differences. There was no statistically significant difference in the rate of emergency room visits 30 days postoperation between the 3 BMI groups (P= 0.6108). Average length of postoperative stay was statistically significant (P= 0.0003) but was low overall (1–2 days). Hospital readmission rates were low, with the lowest rate among morbidly obese patients (2.13%).ConclusionsOur data suggest that laparoscopic gynecologic-oncology procedures for obese patients are feasible and safe.
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Loaec C, Bats AS, Ngo C, Cornou C, Rossi L, Bensaid C, Nos C, Lecuru F. Dual docking robotic surgical staging for high risk endometrial cancer. Eur J Obstet Gynecol Reprod Biol 2018; 225:79-83. [PMID: 29679815 DOI: 10.1016/j.ejogrb.2018.04.009] [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: 01/26/2018] [Revised: 04/03/2018] [Accepted: 04/08/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The standard of care for patients with high intermediate and high risk endometrial cancer is surgical staging including total hysterectomy with bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy. Over the past decade, laparoscopic or robot-assisted minimally invasive surgery has showed many benefits in the management of endometrial cancer. Few studies have specifically assessed the use of minimally invasive surgery for staging of high risk endometrial cancer. The objective of this study was to evaluate the feasibility, the morbidity and oncologic outcomes of dual docking robot-assisted surgical staging of high risk endometrial cancer. METHODS We conducted a retrospective observational study from January 2014 to March 2016 in patients with high risk endometrial cancer who underwent dual docking robotic hysterectomy with pelvic and paraaortic lymphadenectomy (± omentectomy). Patients' demographics, operative time, conversion rate, intra and postoperative complications, pathologic results, length of stay and survival were analyzed. RESULTS Twenty patients met the inclusion criteria. Staging surgical procedure was performed robotically with a dual docking in 18 patients. Two patients were converted to laparotomy (1 for bladder extension, 1 for exposure reasons) and no patient had a laparoconversion for complication (conversion rate 10%). One patient was post operatively re-operated within 30 days because of port hernia. In one case, paraaortic lymphadenectomy was not performed because of hemorrhage risk. When the procedure was performed with robot-assisted surgery, the median number of paraaortic nodes was 19.5 (3-45). The median operative time was 240 min (180-300). Eighty-five percent (17/20) of patients were discharged at day 4 or before. The median time to start adjuvant treatments, when indicated, was 5.5 weeks. With a median follow up of 8 months (1-18 months), no tumor recurrence was reported. CONCLUSION Robotic surgical staging with dual docking in women with high risk endometrial cancer seems to be feasible with few complications. More studies are required to assess the safety of robotic surgery and its impact on survival.
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Affiliation(s)
- Cécile Loaec
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France.
| | - Anne-Sophie Bats
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France; Faculté de Médecine Paris Descartes, Université Paris-Descartes, Paris, France; INSERM UMR-S 1124, Université Paris Descartes, Paris, France
| | - Charlotte Ngo
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France; Faculté de Médecine Paris Descartes, Université Paris-Descartes, Paris, France; INSERM UMR-S 1124, Université Paris Descartes, Paris, France
| | - Caroline Cornou
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France; Faculté de Médecine Paris Descartes, Université Paris-Descartes, Paris, France
| | - Léa Rossi
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France; Faculté de Médecine Paris Descartes, Université Paris-Descartes, Paris, France
| | - Chérazade Bensaid
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France
| | - Claude Nos
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France
| | - Fabrice Lecuru
- Chirurgie Cancérologique Gynécologique et du Sein, Hôpital Européen Georges-Pompidou, Paris, France; Faculté de Médecine Paris Descartes, Université Paris-Descartes, Paris, France; INSERM UMR-S 1147, Université Paris Descartes, Paris, France.
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Wang YR, Lu HF, Huo HC, Qu CP, Sun GX, Shao SQ. A network meta-analysis of comparison of operative time and complications of laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy for endometrial carcinoma. Medicine (Baltimore) 2018; 97:e0474. [PMID: 29703003 PMCID: PMC5944470 DOI: 10.1097/md.0000000000010474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The endometrial carcinoma (EC) is the most frequently occurring female genital cancer. The authors performed this network meta-analysis to compare operative time and the incidence of bowel injury and wound infection of 3 operative approaches (laparoscopy, laparotomy, and laparoscopic-assisted vaginal hysterectomy [LAVH]) in the treatment of EC. METHODS The Cochrane Library, PubMed, and Embase databases were searched. Randomized controlled trials (RCTs) for EC from the day of databases establishment to February 2017 were included. Direct and indirect evidences were combined to calculate the combined weighted mean difference (WMD) or odd ratio values and the surface under the cumulative ranking curve (SUCRA) value of 3 operative approaches in the treatment of EC. RESULTS A total of 9 qualified RCTs were included into the study. The results showed that laparotomy had a shorter-operative time than LAVH (WMD = -40.36, 95% confidence interval = -75.03 to -2.57). However, there was no significant difference in the incidence of bowel injury and wound infection among 3 operative approaches. Besides, the SUCRA values indicated that laparotomy had the shortest operative time but the incidence of bowel injury and wound infection was relatively higher. CONCLUSION The results from this study indicate that laparotomy had highest incidence of bowel injury and wound infection but shortest operative time among 3 operative approaches in the treatment of EC.
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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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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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Ind T, Laios A, Hacking M, Nobbenhuis M. A comparison of operative outcomes between standard and robotic laparoscopic surgery for endometrial cancer: A systematic review and meta-analysis. Int J Med Robot 2017; 13:e1851. [PMID: 28762635 PMCID: PMC5724687 DOI: 10.1002/rcs.1851] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/19/2017] [Accepted: 06/09/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Evidence has been systematically assessed comparing robotic with standard laparoscopy for treatment of endometrial cancer. METHODS A search of Medline, Embase and Cochrane databases was performed until 30th October 2016. RESULTS Thirty-six papers including 33 retrospective studies, two matched case-control studies and one randomized controlled study were used in a meta-analysis. Information from a further seven registry/database studies were assessed descriptively. There were no differences in the duration of surgery but days stay in hospital were shorter in the robotic arm (0.46 days, 95%CI 0.26 to 0.66). A robotic approach had less blood loss (57.74 mL, 95%CI 38.29 to 77.20), less conversions to laparotomy (RR = 0.41, 95%CI 0.29 to 0.59), and less overall complications (RR = 0.82, 95%CI 0.72 to 0.93). A robotic approach had higher costs ($1746.20, 95%CI $63.37 to $3429.03). CONCLUSION A robotic approach has favourable clinical outcomes but is more expensive.
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Affiliation(s)
- Thomas Ind
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
- St George's University of LondonLondonUK
| | - Alex Laios
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
| | - Matthew Hacking
- Department of Gynaecological OncologyRoyal Marsden HospitalLondonUK
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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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Hignett S, Gyi D, Calkins L, Jones L, Moss E. Human Factors Evaluation of Surgeons' Working Positions for Gynecologic Minimal Access Surgery. J Minim Invasive Gynecol 2017; 24:1177-1183. [PMID: 28739415 DOI: 10.1016/j.jmig.2017.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/26/2017] [Accepted: 07/15/2017] [Indexed: 11/16/2022]
Abstract
STUDY OBJECTIVE To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients DESIGN: Mixed methods (Canadian Task Force classification III). SETTING Teaching hospital in the United Kingdom. MEASUREMENTS Survey, observations (anthropometry, postural analysis), and interviews. RESULTS Work-related musculoskeletal disorders (WRMSDs) were present in 63% of the survey respondents (n = 67). The pilot study (n = 11) identified contributory factors, including workplace layout, equipment design, and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average-size mannequin and plus-size mannequin) but not between patient size groups, suggesting that port preference may be driven by surgeon preference (and experience) rather than by patient size. CONCLUSION Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a workplace that supports adaptation to the task, the surgeon, and the patient.
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Affiliation(s)
- Sue Hignett
- Loughborough Design School, Loughborough University, Loughborough, United Kingdom.
| | - Diane Gyi
- Loughborough Design School, Loughborough University, Loughborough, United Kingdom
| | - Lisa Calkins
- Loughborough Design School, Loughborough University, Loughborough, United Kingdom
| | - Laura Jones
- Loughborough Design School, Loughborough University, Loughborough, United Kingdom
| | - Esther Moss
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
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Laursen KR, Hyldgård VB, Jensen PT, Søgaard R. Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006-2013. J Robot Surg 2017; 12:283-294. [PMID: 28695441 DOI: 10.1007/s11701-017-0725-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.
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Affiliation(s)
| | - Vibe Bolvig Hyldgård
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark. .,Health Economics, DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
| | - Pernille Tine Jensen
- Department of Gynecology and Obstetrics, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Lauterbach R, Matanes E, Lowenstein L. Review of Robotic Surgery in Gynecology-The Future Is Here. Rambam Maimonides Med J 2017; 8:RMMJ.10296. [PMID: 28467761 PMCID: PMC5415365 DOI: 10.5041/rmmj.10296] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The authors present a systematic review of randomized and observational, retrospective and prospective studies to compare between robotic surgery as opposed to laparoscopic, abdominal, and vaginal surgery for the treatment of both benign and malignant gynecologic indications. The comparison focuses on operative times, surgical outcomes, and surgical complications associated with the various surgical techniques. PubMed was the main search engine utilized in search of study data. The review included studies of various designs that included at least 25 women who had undergone robotic gynecologic surgery. Fifty-five studies (42 comparative and 13 non-comparative) met eligibility criteria. After careful analysis, we found that robotic surgery was consistently connected to shorter post-surgical hospitalization when compared to open surgery, a difference less significant when compared to laparoscopic surgery. Also, it seems that robotic surgery is highly feasible in gynecology. There are quite a few inconsistencies regarding operative times and estimated blood loss between the different approaches, though in the majority of studies estimated blood loss was lower in the robotic surgery group. The high variance in operative times resulted from the difference in surgeon's experience. The decision whether robotic surgery should become mainstream in gynecological surgery or remain another surgical technique in the gynecological surgeon's toolbox requires quite a few more randomized controlled clinical trials. In any case, in order to bring robotic surgery down to the front row of surgery, training surgeons is by far the most important goal for the next few years.
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Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; and Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Ind TEJ, Marshall C, Hacking M, Chiu S, Harris M, Nobbenhuis M. The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2017; 4:33-37. [PMID: 30697561 PMCID: PMC6193434 DOI: 10.2147/rsrr.s123108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to compare the financial and clinical outcomes in robotic-assisted laparoscopic surgery for primary endometrial cancer between obese and nonobese women. The hospital finance department assessed the total admission costs for robotic surgery for endometrial cancer in 54 women. This included a subanalysis for costs over nine areas (ward and clinics, drugs and pharmacy, medical staff, theaters, blood products, imaging, pathology, rehabilitation therapy, and high dependency costs). Furthermore, a prospective collection of morbidity and surgical outcome data was performed. The study group included 21 nonobese and 33 obese women (body mass index >30). Obese women were more likely to stay for more than one night in hospital (20/33 [60.6%] compared to 4/21 [19.0%], P=0.032) and to have high dependency care (25/33 [75.8%] compared to 10/21 [47.6%], P=0.032). Theater time was on average 35 min longer (95% confidence interval [CI] 5–65 min, P=0.0252). Both the groups were comparable for comorbidities except for the presence of diabetes being present in the obese group (13/33 [39.4%] compared to 0/21 [0.0%], P=0.007). There were six Clavien-Dindo grade II complications in the obese group and two in the nonobese group. The average overall costs were £1,852 greater (95% CI £431–£3,277, P=0.012) in the obese group. Diabetes and hypertension were associated with increased costs, but obesity was the only independent variable. In conclusion, greater resource should be allocated to obese women undergoing primary surgery for endometrial cancer.
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Affiliation(s)
- Thomas E J Ind
- Department of Gynaecological Oncology, Royal Marsden Hospital, .,Department of Obstetrics and Gynaecology, St. George's University of London,
| | | | - Matthew Hacking
- Department of Anaesthesia, Royal Marsden Hospital, London, UK
| | - Selina Chiu
- Department of Gynaecological Oncology, Royal Marsden Hospital,
| | - Michelle Harris
- Department of Gynaecological Oncology, Royal Marsden Hospital,
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Does Surgical Teaching Take Time? Resident Participation in Minimally Invasive Hysterectomy for Endometrial Cancer. J Minim Invasive Gynecol 2017; 24:783-789. [PMID: 28336363 DOI: 10.1016/j.jmig.2017.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/11/2017] [Accepted: 03/13/2017] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To determine the association between resident involvement and operative time for minimally invasive surgery (MIS) for endometrial cancer. DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING An integrated health care system in Northern California. PATIENTS A total of 1433 women who underwent MIS for endometrial cancer and endometrial intraepithelial neoplasia from January 2009 to January 2014. INTERVENTIONS Resident participation in 430 of 688 laparoscopic cases (62%) and 341 of 745 robotic cases (46%). MEASUREMENTS AND MAIN RESULTS The primary outcome was the impact of resident involvement on surgical time. When residents were involved in laparoscopic and robotic surgery, there was an increase of 61 minutes (median operative time, 186 vs 125 minutes; p < .001) and 31 minutes (median operative time, 165 vs 134 minutes; p < .001), respectively. Resident participation was associated with increased operative times in all levels of surgical complexity from hysterectomy alone to hysterectomy with pelvic and para-aortic lymph node dissection. Resident participation was also associated with increased major intraoperative complications (3.4% vs 1.8%, p = .02) as well as major postoperative complications (6.4% vs 3.8%, p = .003). CONCLUSION The presence of a resident was associated with a 32% increase in operative time for minimally invasive cases in gynecologic oncology for endometrial cancer. Because of the retrospective nature, we cannot infer causality of operative outcomes because residents were also involved in more high-risk patients and complex cases. For health care systems using surgical metrics, there may be a need to allocate more time for resident involvement.
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Zanagnolo V, Garbi A, Achilarre MT, Minig L. Robot-assisted Surgery in Gynecologic Cancers. J Minim Invasive Gynecol 2017; 24:379-396. [PMID: 28104497 DOI: 10.1016/j.jmig.2017.01.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/09/2017] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
Robotic-assisted surgery is a technological advancement that facilitates the application of minimally invasive techniques for complex operations in gynecologic oncology. The objective of this article was to review the literature regarding the role of robotic-assisted surgery to treat women with gynecologic cancers. The majority of publications on robotic surgery are still retrospective or descriptive in nature; however, the data for managing patients with a robotic-assisted approach show comparable, and at times improved, outcomes compared with both laparoscopy (2-dimensional) and laparotomy approaches. Robotic-assisted surgery has been used for patients with endometrial cancer and resulted in the increased use of minimally invasive surgery with improved outcomes compared with laparotomy and partially with laparoscopy. This has been shown in large cohorts of patients as well as in obese patients in whom the complication rates have significantly decreased. For early cervical cancer, robotic radical hysterectomy seems to be safe and feasible and to be preferable to laparotomy with seemingly comparable oncologic outcomes. Robotic-assisted surgery and conventional laparoscopy to stage women with early-stage ovarian cancer seem to have similar surgical and oncologic outcomes, with a shorter learning curve for robotic-assisted surgery. However, robotic-assisted surgery appears to be more expensive than laparotomy and traditional laparoscopy. In conclusion, robotic-assisted surgery appears to facilitate the surgical approach for complex operations to treat women with gynecologic cancers. Although randomized controlled trials are lacking to further elucidate the equivalence of robot-assisted surgery with conventional methods in terms of oncologic outcome and patients' quality of life, the technology appears to be safe and effective and could offer a minimally invasive approach to a much larger group of patients.
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Affiliation(s)
- Vanna Zanagnolo
- Gynecology Department, European Institute of Oncology, Milan, Italy.
| | - Annalisa Garbi
- Gynecology Department, European Institute of Oncology, Milan, Italy
| | | | - Lucas Minig
- Gynecology Department, Instituto Valenciano de Oncología, Valencia, Spain
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