1
|
Gruhl SL, Yusoff MA, Chin HMS, Nadarajah R. An eight-year analysis of robotic surgery in morbidly obese women with endometrial cancer in a tertiary center in Singapore. Eur J Obstet Gynecol Reprod Biol X 2024; 23:100330. [PMID: 39188906 PMCID: PMC11347051 DOI: 10.1016/j.eurox.2024.100330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/24/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Surgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and Methods We performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. Results The average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. Conclusion Robotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.
Collapse
Affiliation(s)
- Sabrina Lasini Gruhl
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Muhammad Ashraf Yusoff
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Hui Men Selina Chin
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| | - Ravichandran Nadarajah
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Outram Rd, 169608, Singapore
| |
Collapse
|
2
|
Bizoń M, Olszewski M, Grabowska A, Mawlichanów K, Pilka R. Robotic surgery in endometrial cancer: first Polish experience. J Robot Surg 2024; 18:14. [PMID: 38216814 DOI: 10.1007/s11701-023-01752-2] [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: 09/10/2023] [Accepted: 11/24/2023] [Indexed: 01/14/2024]
Abstract
In Poland, robotic surgery is nowadays perceived as a new method of surgical treatment in endometrial cancer patients. We aim to present the first Polish group of endometrial cancer patients treated using robotic surgery. The analysis was based on 79 patients with mean age of 59.72 ± 11.709 (range 27-83) years and endometrial cancer scheduled for surgical treatment. Mean BMI was 31.38 ± 8.78 (range 19.03-65.97) kg/m2. The data were collected based on a questionnaire consisting of 19 questions concerning the patient's perception of robotic surgery before the procedure. Patients with a family history of neoplastic diseases indicate precision of movements as the most important reason for choosing robotic surgery (p = 0.0035). Patients after surgery procedures in the past named shorter hospitalization as a major benefit (p = 0.0037). Patients who chose robotic surgery for financial reasons stressed the cosmetic effect as a priority (p = 0.0319). Shorter length of hospital stay, less blood loss, enlarged view, and good visualization were statistically significant reasons for choosing robotic surgery (p < 0.05). Women who consider work, good material status, and well-being as the most important aspects of their lives cited the cosmetic effect as a benefit of robotic surgery (p = 0.0029 vs. p = 0.0074 vs. p = 0.01745, respectively). In the follow-up after operations, no patients regretted choosing robotic surgery. Good visualization, precise movements, less blood loss, and cosmetic effects are the most frequent reasons for choosing robotic surgery. Even patients after other types of surgery in the past decided on robot-assisted radical hysterectomy because of the clear benefits of this approach.
Collapse
Affiliation(s)
- Magdalena Bizoń
- LUX MED Oncology Hospital, św. Wincentego 103, Warsaw, Poland.
- Neohospital, Kostrzewskiego 47, Cracow, Poland.
- Lazarski University, Warsaw, Poland.
| | - Maciej Olszewski
- LUX MED Oncology Hospital, św. Wincentego 103, Warsaw, Poland
- Neohospital, Kostrzewskiego 47, Cracow, Poland
- Lazarski University, Warsaw, Poland
| | | | - Krzysztof Mawlichanów
- Neohospital, Kostrzewskiego 47, Cracow, Poland
- Andrzej Frycz Modrzewski Krakow University, Cracow, Poland
| | - Radovan Pilka
- Neohospital, Kostrzewskiego 47, Cracow, Poland
- Department of Obstetrics and Gynecology, University Hospital Olomouc, Palacky University Medical Faculty, Olomouc, Czech Republic
| |
Collapse
|
3
|
Wong JJ, Chan GM, Low JJ, Ng JS. A perfect match: The story of robotics in gynaecology. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:331-332. [PMID: 38904516 DOI: 10.47102/annals-acadmedsg.202388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
The first use of surgical robotics started in the domain of orthopaedic and urological surgery. However, it was the initial concept of using a robot in performing remote damage control surgeries on the battlefield that sparked the commercialisation of robotic surgical technology for use in operating rooms.1
Collapse
Affiliation(s)
- Jeslyn Jl Wong
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Grace Mf Chan
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Jeffrey Jh Low
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Joseph S Ng
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| |
Collapse
|
4
|
Gruhl SL, Yusoff MA, Chin HMS, Nadarajah R. Robotic surgery in morbidly obese women with endometrial cancer in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:161-163. [PMID: 38904495 DOI: 10.47102/annals-acadmedsg.20234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Affiliation(s)
| | | | - Hui Men Selina Chin
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | | |
Collapse
|
5
|
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: 4] [Impact Index Per Article: 1.3] [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.
Collapse
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.
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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: 22] [Impact Index Per Article: 5.5] [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.
Collapse
|
9
|
Chinder PS, Hindiskere S, Doddarangappa S, Sk R, Mascarenhas A, Pal U. Robotic Surgery Assisted Staged En-Bloc Sacrectomy for Sacral Chordoma: A Case Report. JBJS Case Connect 2019; 9:e0240. [PMID: 31140987 DOI: 10.2106/jbjs.cc.18.00240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE Two male patients aged 37 years and 39 years, diagnosed with sacral chordoma, underwent robotic-assisted preparatory adhesiolysis from the anterior aspect of the tumor, followed by posterior en-bloc partial sacrectomy. The average total operative time was 360 minutes (anterior docking + anterior console + posterior excision), and mean blood loss was 930 mL. Both patients were mobilized early, had no postoperative complications, and were free of local recurrence at 18 month of follow-up. CONCLUSIONS Robotic-assisted surgery is a novel, valid, safe, and minimally invasive technique which drastically reduces the associated surgical complications of single-staged posterior sacrectomy, resulting in excellent functional and oncological outcome.
Collapse
Affiliation(s)
- Pramod S Chinder
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
| | - Suraj Hindiskere
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
| | | | - Raghunath Sk
- Department of Uro Oncology. HCG Hospital, Bangalore, India
| | | | - Utkarsh Pal
- Department of Musculoskeletal Oncology, HCG Hospital, Bangalore, India
| |
Collapse
|
10
|
Lundin ES, Wodlin NB, Nilsson L, Kjölhede P. A prospective randomized assessment of quality of life between open and robotic hysterectomy in early endometrial cancer. Int J Gynecol Cancer 2019; 29:ijgc-2019-000285. [PMID: 30923082 DOI: 10.1136/ijgc-2019-000285] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/09/2019] [Accepted: 01/23/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There are limited prospective data on the evaluation of quality of life in patients undergoing robotic hysterectomy for endometrial cancer. Our objective was to determine whether post-operative recovery differs between robotic and abdominal hysterectomy. METHODS At a Swedish tertiary referral university hospital, 50 women with low-risk endometrial cancer scheduled for surgery between February 2012 and May 2016 were included in a randomized trial. Surgery was performed according to principles for minimal invasive surgery. Anesthesia and peri-operative care followed a standardized enhanced recovery after surgery program in both groups. The EuroQol Group form EQ-5D and the Short Form-36 were used to evaluate patients' health-related quality of life. The Swedish Postoperative Symptoms Questionnaire assessed symptoms pre-operatively, daily for 7 days from the day of surgery, and then weekly until 6 weeks post-operatively. Data were analyzed by means of non-parametric tests and repeated measures ANOVA. To evaluate the time-dependent occurrence of complications, Kaplan-Meier survival and Cox proportional-hazard models were used. RESULTS A total of 50 women were enrolled in the study (25 robotic and 25 abdominal hysterectomy). Median age (68 years vs 67 years), estimated blood loss (50 mL vs 50 mL), length of hospital stay de facto (53 hours vs 51 hours), and time to meet discharge criteria (36 hours vs 36 hours) in the robotic and abdominal groups, respectively, did not differ significantly (p>0.05) Women in the robotic hysterectomy group recovered significantly faster (p=0.01) in the EQ-5D health index, and reached their pre-operative level after approximately 3 weeks, nearly 2 weeks earlier than the abdominal group. Differences regarding improvement in health-related quality of life (Short Form-36) were statistically significant in general health and social functioning only, and were in favor of robotic hysterectomy. Consumption of analgesics, pain intensity, and symptom sum score post-operatively were equal. Occurrence of complications was an independent risk factor and influenced significantly the EQ-5D health index, length of hospital stay, pain intensity, opioid consumption, and symptom sum score adversely. CONCLUSION Robotic hysterectomy in the setting of an enhanced recovery after surgery program led to faster recovery in health-related quality of life compared with abdominal hysterectomy.
Collapse
Affiliation(s)
- Evelyn Serreyn Lundin
- Children and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ninnie Borendal Wodlin
- Children and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Lena Nilsson
- Anesthesiology and Intensive Care, Linköpings universitet, Linköping, Sweden
| | - Preben Kjölhede
- Children and Women's Health, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
11
|
Agarwal R, Rajanbabu A, Goel G, Unnikrishnan UG. A Comparison of the Clinical Outcomes in Uterine Cancer Surgery After the Introduction of Robotic-Assisted Surgery. J Obstet Gynaecol India 2018; 69:284-291. [PMID: 31178646 DOI: 10.1007/s13224-018-1170-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 08/12/2018] [Indexed: 01/07/2023] Open
Abstract
Objective To compare the rates of intraoperative and postoperative complications of open and robotic-assisted surgery in the treatment of endometrial cancer. Methods This retrospective study was performed at a single academic institution from January 2014 to February 2017 in the Department of Gynecology Oncology at Amrita Institute of Medical Science, Kerala, India. The study included patients with clinically early stage uterine malignancy undergoing open or robotic-assisted surgery. Data collected included clinicopathological factors, intraoperative data, length of hospital stay and intraoperative and postoperative (early and late and severity according to Clavien-Dindo classification). Morbidity was compared between two groups. Results The study included 128 patients, of whom 61 underwent open surgery and 67 underwent robotic-assisted surgery. Mean operative time (P = 0.112), mean estimated blood loss (P < 0.001), number of patients requiring blood transfusion (P < 0.001) and mean length of hospital stay (P < 0.001) were significantly lower in robotic group. None of the patients in robotic group experienced intraoperative hemorrhage (P = 0.010). The early postoperative complications, SSI (P < 0.001), infection (P = 0.002), and urinary complications (P = 0.030) and late postoperative complications lymphoedema (P = 0.002), vault-related complications (1.5% robotic vs. 6.6% open) and incisional hernia (none in robotic vs. 4.9% in open) were significantly lower in robotic group. Grade-II complications (Clavien-Dindo classification) were significantly lower in robotic group (P < 0.001). Conclusion Robotic-assisted surgical staging for uterine cancer is feasible and safe in terms of short-term outcomes and results in fewer complications and shorter hospital stay.
Collapse
Affiliation(s)
- Reshu Agarwal
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - Anupama Rajanbabu
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - Gaurav Goel
- 1Department of Gynecologic Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala 682041 India
| | - U G Unnikrishnan
- 2Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala India
| |
Collapse
|
12
|
Picerno T, Sloan NL, Escobar P, Ramirez PT. Bowel injury in robotic gynecologic surgery: risk factors and management options. A systematic review. Am J Obstet Gynecol 2017; 216:10-26. [PMID: 27640938 DOI: 10.1016/j.ajog.2016.08.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/22/2016] [Accepted: 08/31/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to analyze the published literature on bowel injuries in patients undergoing gynecologic robotic surgery with the aim to determine its incidence, predisposing factors, and treatment options. DATA SOURCES Studies included in this analysis were identified by searching PubMed Central, OVID Medline, EMBASE, Cochrane, and ClinicalTrials.gov databases. References for all studies were also reviewed. Time frame for data analysis spanned from November 2001 through December 2014. STUDY ELIGIBILITY CRITERIA All English-language studies reporting the incidence of bowel injury or complications during robotic gynecologic surgery were included. Studies with data duplication, not in English, case reports, or studies that did not explicitly define bowel injury incidence were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS The Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies were used to complete the systematic review with the exception of scoring study quality and a single primary reviewer. RESULTS In all, 370 full-text articles were reviewed and 144 met the inclusion criteria. There were 84 bowel injuries recorded in 13,444 patients for an incidence of 1 in 160 (0.62%; 95% confidence interval, 0.50-0.76%). There were no significant differences in incidence of bowel injury by procedure type. The anatomic location of injury, etiology, and management were rarely reported. Of the bowel injuries, 87% were recognized intraoperatively and the majority (58%) managed via a minimally invasive approach. Of 13,444 patients, 3 (0.02%) (95% confidence interval, 0.01-0.07%) died in the immediate postoperative period and no deaths were a result of a bowel injury. CONCLUSION The overall incidence of bowel injury in robotic-assisted gynecologic surgery is 1 in 160. When the location of bowel injuries were specified, they most commonly occurred in the colon and rectum and most were managed via a minimally invasive approach.
Collapse
|
13
|
Comparative safety and effectiveness of robot-assisted laparoscopic hysterectomy versus conventional laparoscopy and laparotomy for endometrial cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2016; 42:1303-14. [DOI: 10.1016/j.ejso.2016.06.400] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/22/2016] [Accepted: 06/22/2016] [Indexed: 01/26/2023] Open
|
14
|
Nevis IF, Vali B, Higgins C, Dhalla I, Urbach D, Bernardini MQ. Robot-assisted hysterectomy for endometrial and cervical cancers: a systematic review. J Robot Surg 2016; 11:1-16. [PMID: 27424111 DOI: 10.1007/s11701-016-0621-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/27/2016] [Indexed: 12/31/2022]
Abstract
Total and radical hysterectomies are the most common treatment strategies for early-stage endometrial and cervical cancers, respectively. Surgical modalities include open surgery, laparoscopy, and more recently, minimally invasive robot-assisted surgery. We searched several electronic databases for randomized controlled trials and observational studies with a comparison group, published between 2009 and 2014. Our outcomes of interest included both perioperative and morbidity outcomes. We included 35 observational studies in this review. We did not find any randomized controlled trials. The quality of evidence for all reported outcomes was very low. For women with endometrial cancer, we found that there was a reduction in estimated blood loss between the robot-assisted surgery compared to both laparoscopy and open surgery. There was a reduction in length of hospital stay between robot-assisted surgery and open surgery but not laparoscopy. There was no difference in total lymph node removal between the three modalities. There was no difference in the rate of overall complications between the robot-assisted technique and laparoscopy. For women with cervical cancer, there were no differences in estimated blood loss or removal of lymph nodes between robot-assisted and laparoscopic procedure. Compared to laparotomy, robot-assisted hysterectomy for cervical cancer showed an overall reduction in estimated blood loss. Although robot-assisted hysterectomy is clinically effective for the treatment of both endometrial and cervical cancers, methodologically rigorous studies are lacking to draw definitive conclusions.
Collapse
Affiliation(s)
- Immaculate F Nevis
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada.
| | - Bahareh Vali
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
| | - Caroline Higgins
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
| | - Irfan Dhalla
- Health Quality Ontario, 130 Bloor Street West, 10th Floor, Toronto, ON, M5S 1N5, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - David Urbach
- Toronto General Hospital, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Marcus Q Bernardini
- Department of Gynecologic Oncology, Princess Margaret Hospital, University of Toronto, 610, University Avenue, Toronto, ON, M5G 2M9, Canada
| |
Collapse
|
15
|
A Prospective, Comparative Study on Robotic Versus Open-Surgery Hysterectomy and Pelvic Lymphadenectomy for Endometrial Carcinoma. Int J Gynecol Cancer 2015; 25:250-6. [DOI: 10.1097/igc.0000000000000357] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectivesThe aim of this study was to compare surgical outcome, patient recovery, and costs between robot-assisted laparoscopy and laparotomy in women undergoing hysterectomy, bilateral salpingo-oophorectomy (BSOE), and pelvic lymphadenectomy for endometrial carcinoma.MethodsWomen undergoing hysterectomy, BSOE, and pelvic lymphadenectomy for endometrial carcinoma, according to regional guidelines, were prospectively, concurrently, and consecutively included from September 2010 to December 2012. Surgical outcomes such as operative time, estimated blood loss (EBL), number of lymph nodes retrieved, and complications were analyzed together with hospital stay, days until normal active daily living was retrieved, patient satisfaction with the length of the hospital stay, and cost per patient. Robot-assisted laparoscopy was performed on all cases at the Sahlgrenska University Hospital, and laparotomy was performed on all cases at 3 regional hospitals.ResultsForty women underwent robot-assisted laparoscopy, and 48 underwent laparotomy. There were no differences in age, body mass index, histology, or retrieved lymph nodes. Operative time was significantly shorter in the robot-assisted laparoscopy group (P< 0.0001). The EBL was lower and hospital stay was shorter in the robot-assisted laparoscopy group (P< 0.0001). There was no statistical difference in complications between the groups, and both groups found hospital stay duration satisfactory. In the robot-assisted laparoscopy group, active daily living was normal within 5 days postoperatively, compared with 14 days in the laparotomy group (P< 0.0001). Calculated costs per treated patient did not differ statistically between the groups.ConclusionsCompared with laparotomy and robot-assisted laparoscopic hysterectomy, BSOE pelvic lymphadenectomy for endometrial carcinoma was associated with significantly shorter operative time, hospital stay, and lower EBL. Patients recovered more quickly after robot-assisted laparoscopy, with equal costs number of retrieved lymph nodes, compared with laparotomy.
Collapse
|
16
|
Perioperative and Long-term Outcomes of Laparoscopic, Open Abdominal, and Vaginal Surgery for Endometrial Cancer in Patients Aged 80 Years or Older. Int J Gynecol Cancer 2014; 24:894-900. [PMID: 24819659 DOI: 10.1097/igc.0000000000000128] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveThis study was undertaken to evaluate the safety, feasibility, and the long-term effectiveness of laparoscopy in endometrial cancer patients aged 80 years or older.MethodsData of consecutive patients aged 80 years and older undergoing laparoscopic, open abdominal, and vaginal approaches were compared. Postoperative complications were graded per the Accordion Severity Classification. Survival outcomes within the first 5 years were analyzed using the Kaplan-Meier method.ResultsAmong 726 patients, 63 (9%) were aged 80 years and older. Laparoscopic, open abdominal, and vaginal surgery were performed in 22 (35%), 25 (40%), and 16 (25%) cases, respectively. All laparoscopic procedures were completed laparoscopically, whereas a conversion from vaginal to open procedure occurred (0% vs 6%; P = 0.42). Patients undergoing laparoscopy experienced similar operative time (P > 0.05), lower blood loss (P < 0.05), and shorter hospital stay (P < 0.05) than patients undergoing open and vaginal surgery. No intraoperative complications were recorded. Laparoscopy is related to a lower rate of postoperative complications (P = 0.09) and Accordion grade greater than or equal to 2 complications (P = 0.05) in comparison to open abdominal and vaginal surgery. The route of surgical approaches did not influence the 5-year disease-free (P = 0.97, log-rank test) and overall (P = 0.94, log-rank test) survivals.ConclusionsLaparoscopy seems to represent a safe and effective treatment of endometrial cancer in women aged 80 years or older. Our data suggest that in elderly women, laparoscopic surgery improves perioperative outcomes compared with open and vaginal approaches without compromising long-term survival.
Collapse
|
17
|
Tapper AM, Hannola M, Zeitlin R, Isojärvi J, Sintonen H, Ikonen TS. A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions. Eur J Obstet Gynecol Reprod Biol 2014; 177:1-10. [PMID: 24703710 DOI: 10.1016/j.ejogrb.2014.03.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 02/19/2014] [Accepted: 03/06/2014] [Indexed: 11/15/2022]
Abstract
In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery.
Collapse
Affiliation(s)
- Anna-Maija Tapper
- Department of Gynecology and Pediatrics, Helsinki University Hospital, HUCH, Finland.
| | | | | | - Jaana Isojärvi
- Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Finland.
| | - Harri Sintonen
- Hjelt Institute/Department of Public Health, University of Helsinki, Finland.
| | - Tuija S Ikonen
- Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Hospital District of Southwest Finland, PB 52, 20521 Turku, Finland.
| |
Collapse
|
18
|
Robotics in Endometrial Cancer Care. ROBOTICS 2013. [DOI: 10.3390/robotics2040198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
19
|
Comparative effectiveness of laparoscopic versus robot-assisted colorectal resection. Surg Endosc 2013; 28:212-21. [PMID: 23996335 DOI: 10.1007/s00464-013-3163-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/31/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND During the past 20 years, laparoscopy has revolutionized colorectal surgery. With proven benefits in patient outcomes and healthcare utilization, laparoscopic colorectal surgery has steadily increased in use. Robotic surgery, a new addition to colorectal surgery, has been suggested to facilitate and overcome limitations of laparoscopic surgery. Our objective was to compare the outcomes of robot-assisted laparoscopic resection (RALR) to laparoscopic resections (LAP) in colorectal surgery. METHODS A national inpatient database was evaluated for colorectal resections performed over a 30-month period. Cases were divided into traditional LAP and RALR resection groups. Cost of robot acquisition and servicing were not measured. Main outcome measures were hospital length of stay (LOS), operative time, complications, and costs between groups. RESULTS A total of 17,265 LAP and 744 RARL procedures were identified. The RALR cases had significantly higher total cost ($5,272 increase, p < 0.001) and direct cost ($4,432 increase, p < 0.001), significantly longer operating time (39 min, p < 0.001), and were more likely to develop postoperative bleeding (odds ratio 1.6; p = 0.014) than traditional laparoscopic patients. LOS, complications, and discharge disposition were comparable. Similar findings were noted for both laparoscopic colonic and rectal surgery. CONCLUSIONS RALR had significantly higher costs and operative time than traditional LAP without a measurable benefit.
Collapse
|
20
|
Current World Literature. Curr Opin Obstet Gynecol 2013; 25:81-9. [DOI: 10.1097/gco.0b013e32835cc6b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|