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Liu Y, Zhao Z, Xu P, Li Y, Chang W, Ji M. Initial experience with the Carina™ platform in robotic-assisted hysterectomy for gynecological malignant disease. Surg Endosc 2025; 39:2346-2353. [PMID: 39966128 PMCID: PMC11933141 DOI: 10.1007/s00464-025-11588-6] [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: 11/12/2024] [Accepted: 01/26/2025] [Indexed: 02/20/2025]
Abstract
OBJECTIVE This retrospective study was performed to evaluate the efficiency and safety of a new modular robotic system, the Carina™ Platform (Ronovo Surgical, Shanghai, China), in gynecological surgery. METHODS All patients underwent robotic hysterectomies (RH) using the Carina performed by a single gynecologist experienced in laparoscopic and robotic surgery from November to December 2023. Patients were evaluated for estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, conversion rate, as well as console and docking times. RESULTS Two separate populations were involved: 10 cervical cancer patients (group 1) and six endometrial cancer patients (group 2). There were no conversions to laparotomies or laparoscopies. The mean docking time was 5.75 ± 2.38 min. The mean console time and mean operative time were 154.60 ± 26.01 min and 211.90 ± 53.65 min in group 1, respectively. The mean console time and mean operative time were 98.67 ± 26.71 min and 153.33 ± 22.77 min in group 2, respectively. The median estimated blood loss for group 1 and group 2 were 30 ml (20, 50) and 20 ml (7.5, 20), respectively. No intraoperative or postoperative complications related to the device were recorded. CONCLUSION Our experience allows us to state that the modular Carina Platform is safe and efficient in complex gynecologic surgery. CLINICAL TRIAL REGISTRATION researchregistry10353 https://www.researchregistry.com/browse-the-registry#home/registrationdetails/665c1a398a97c302739cce06/.
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Affiliation(s)
- Yafen Liu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China
| | - Zhao Zhao
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China
| | - Penglin Xu
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China
| | - Yue Li
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China
| | - Weizhong Chang
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China
| | - Mei Ji
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe East Road, Erqi District, Zhengzhou, Henan, People's Republic of China.
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Yuan Y, Tan Q, Chen Y, Zhu K, Pan B, Liu B, Ren C, Li G, Chen C, Zhao C. Different surgical methods of hysterectomy for the management of endometrial cancer: a systematic review and network meta-analysis. Front Oncol 2025; 14:1524991. [PMID: 39882446 PMCID: PMC11774694 DOI: 10.3389/fonc.2024.1524991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 12/16/2024] [Indexed: 01/31/2025] Open
Abstract
Background Emerging surgical methods are utilized to treat endometrial cancer. The study aimed to assess the efficacy and safety of four common surgical methods of hysterectomy. Methods We systematically searched the PubMed, Cochrane Library databases, Medline, EMBASE and Web of Science from their inception until April 30, 2024. We used hazard ratios (HR) for overall survival (OS) and disease-free (DFS), odds ratios (OR) for categorical outcomes, and mean differences (MD) for continuous outcomes with 95% confidence intervals. These were pooled in Bayesian network meta-analysis models. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome. Results Thirty studies comprising 13446 patients were included. Robotic hysterectomy (RH) retrieved fewer pelvic lymph nodes than open hysterectomy (OH). OH showed a significantly higher postoperative complication rate than laparoscopic hysterectomy (LH) and RH. LH had a higher intraoperative complication rate than OH. According to SUCRA values, OH ranked the highest in the number of retrieved pelvic lymph nodes (0.89), intraoperative complications (0.73), and operative time (0.97). LH ranked the highest in DFS (0.81) and overall survival (OS) (0.87). RH ranked the highest in the postoperative complications (0.95). Laparoscopic-assisted vaginal hysterectomy (LAVH) ranked the highest in number of retrieved para-aortic lymph nodes (0.72). Conclusions There are no significant differences among the four surgical methods in DFS or OS. The use of uterine manipulators does not affect prognosis. OH is the best method for shortening operative time, dissecting the pelvic lymph nodes and controlling intraoperative complications. LH and LAVH have an advantage in para-aortic lymph node dissection. Besides, LH has the best advantage in DFS and OS. RH has advantages in controlling surgical complications. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024529974.
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Affiliation(s)
- Yuquan Yuan
- Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Gynecologic Oncology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Qin Tan
- Department of Neonatology, Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Yingfan Chen
- Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Keyang Zhu
- Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Bin Pan
- Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Bao Liu
- Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Gynecologic Oncology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Chunyan Ren
- Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Gynecologic Oncology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Ganghui Li
- Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Gynecologic Oncology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Chen
- Chongqing General Hospital, Chongqing University, Chongqing, China
| | - Chengzhi Zhao
- Department of Gynecologic Oncology, Chongqing Health Center for Women and Children, Chongqing, China
- Department of Gynecologic Oncology, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
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Ioana JT(PM, Voiță-Mekereș F, Motofelea AC, Ciprian D, Fulger L, Alexandru I, Tarta C, Stelian P, Bernad ES, Teodora H. Surgical Outcomes in Laparoscopic Hysterectomy, Robotic-Assisted, and Laparoscopic-Assisted Vaginal Hysterectomy for Uterine and Cervical Cancers: A Systematic Review. Diagnostics (Basel) 2024; 14:2782. [PMID: 39767143 PMCID: PMC11674910 DOI: 10.3390/diagnostics14242782] [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: 09/18/2024] [Revised: 11/28/2024] [Accepted: 12/05/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND/OBJECTIVES This systematic review aimed to evaluate the outcomes of minimally invasive techniques in gynecological cancer surgery, specifically laparoscopic hysterectomies (LHs), robotic-assisted hysterectomies (RHs), and laparoscopic-assisted vaginal hysterectomies (LAVHs). METHODS We conducted a comprehensive search of electronic databases including PubMed and MedLine from January 2010 to August 2024. The search included randomized controlled trials (RCTs) and observational studies. Studies were selected based on inclusion criteria such as a focus on LHs, RHs, or LAVHs, and reporting on key outcomes like recovery rates, overall survival (OS) rates, disease-free survival (DFS), postoperative complications, and surgery time. Exclusion criteria were applied to omit non-randomized studies, non-English publications, and those lacking relevant data. RESULTS The analysis included 35 studies on gynecological cancers and surgical procedures, conducted across multiple countries. Among them, 8 were RCTs from countries like the Netherlands and Italy, while 20 were retrospective cohort studies from China and the USA. The studies varied in design, cancer type, and participant age, highlighting diverse surgical approaches and the adaptation of minimally invasive techniques in gynecological cancer treatment. LH and RH demonstrated similar oncological safety with comparable OS and DFS rates. RH was associated with reduced blood loss, but longer operative times compared to LH. LAVH showed favorable perioperative outcomes, including shorter hospital stays and faster recovery, but was less frequently studied in advanced-stage cancers. Complication rates were generally lower in minimally invasive surgeries compared to open procedures. The findings support the efficacy of LH and RH as viable alternatives to open surgery, with specific advantages depending on patient and disease characteristics. CONCLUSIONS Minimally invasive techniques in gynecological cancer surgery offer significant advantages in terms of recovery and complication rates. Despite these benefits, further research is needed to confirm their oncological safety and overall effectiveness compared to traditional open surgeries.
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Affiliation(s)
- Jabri Tabrizi (Plic) Madalina Ioana
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Florica Voiță-Mekereș
- Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Alexandru Catalin Motofelea
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Duta Ciprian
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.C.); (L.F.); (I.A.); (C.T.); (P.S.)
| | - Lazăr Fulger
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.C.); (L.F.); (I.A.); (C.T.); (P.S.)
| | - Isaic Alexandru
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.C.); (L.F.); (I.A.); (C.T.); (P.S.)
| | - Cristi Tarta
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.C.); (L.F.); (I.A.); (C.T.); (P.S.)
| | - Pantea Stelian
- Department of General Surgery, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania; (D.C.); (L.F.); (I.A.); (C.T.); (P.S.)
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
| | - Hoinoiu Teodora
- Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania;
- Department of Clinical Practical Skills, “Victor Babes” University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
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Raimondo D, Raffone A, Neola D, de Landsheere L, de Leeuw RA, Mereu L, Badotti T, Pazzaglia E, Seracchioli R, Scambia G, Fanfani F. Comparison between learning curves of robot-assisted and laparoscopic surgery in gynaecology: a systematic review. Facts Views Vis Obgyn 2024; 16:399-407. [PMID: 39718324 DOI: 10.52054/fvvo.16.4.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2024] Open
Abstract
Background The advantages and disadvantages of Robotic Laparoscopic Surgery (RLS) compared to other minimally invasive surgical approaches are debated in the literature. Objective To evaluate the learning curves (LC) and their assessment methods for Robotic Laparoscopic Surgery (RLS) and Laparoscopic Surgery (LPS) in gynaecologic procedures. Materials and Methods A systematic review of the literature was performed including the English language observational or interventional studies reporting the absolute number of procedures needed to achieve competency in RLS and LPS gynaecologic procedures, along with an objective and reproducible LC assessment method. Main outcome measures Number of procedures needed to achieve competency in RLS and LPS and LC assessment methods were extracted from included studies. Results Six studies with a total of 545 women were included. Several surgical procedures and methods for LC assessment were assessed in the included studies. For radical hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection, the minimum number of procedures required to reach the LC was smaller in RLS than LPS in two studies out of four. For sacrocolpopexy, the number of procedures required to reach the LC was lower in RLS and LPS in one study out of two. Conclusion RLS learning curve was reported to be quicker than that of LPS for radical hysterectomy, bilateral salpingo-oophorectomy and lymph node dissection. However, a standardised and widely accepted method for LC assessment in endoscopic surgery is needed, as well as further randomised clinical trials, especially involving inexperienced surgeons. What is new? This study may be the first systematic review to evaluate the LCs and their assessment methods for RLS and LPS in gynaecologic procedures.
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Grube M, Castan M, Drechsel-Grau A, Praetorius T, Greif K, Staebler A, Neis F, Rall K, Kraemer B, Kommoss S, Andress J. Diagnostics and Surgical Treatment of Deep Endometriosis-Real-World Data from a Large Endometriosis Center. J Clin Med 2024; 13:6783. [PMID: 39597928 PMCID: PMC11594599 DOI: 10.3390/jcm13226783] [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: 09/10/2024] [Revised: 10/22/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024] Open
Abstract
Background: Deep endometriosis (DE) is a special form of endometriosis, one of the most common benign diseases in gynecology. In the specific case of DE, ectopic endometrium can be found not only in peritoneal but also in deeper tissue layers or even as parenchymal organ infiltration. Symptoms include dysmenorrhea, dyspareunia, dyschezia, and dysuria, as well as asymptomatic hydronephrosis or other organ dysfunctions. Due to a pathogenesis of the disease that has not been conclusively clarified to date, no causal therapy exists, which is why surgical resection of DE is still the gold standard for symptomatic cases. Methods: This article retrospectively describes the challenges in diagnosis and surgical treatment of DE at a German Level III Endometriosis Center, with a focus on diagnosis and surgical treatment, as well as the analysis of perioperative and postoperative complications. Results: The surgical treatment of DE is performed in most cases by minimally invasive laparoscopy (94.1%), whereas complex procedures such as ureterolysis, adhesiolysis, or preparation of the rectovaginal septum are considered standard procedures as well. The complexity of the procedures is further underlined by a high need for interdisciplinary operations (28%). Despite high complexity, severe postoperative complications occurred in only 3.1% of surgeries, with the complication rate being significantly higher whenever bowel surgery was necessary for DE resection. Conclusions: Our results emphasize the complexity and interdisciplinary nature of the disease. Therefore, treatment should preferably take place at an endometriosis center of the highest level with experienced, well-coordinated teams.
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Affiliation(s)
- Marcel Grube
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
- Department of Gynecology and Obstetrics, Diak Klinikum Schwaebisch Hall, Diakoniestrasse 10, 74523 Schwaebisch Hall, Germany
| | - Maren Castan
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Alexander Drechsel-Grau
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
- Department of Urology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9000 St. Gallen, Switzerland
| | - Teresa Praetorius
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
- Department of Gynecology and Obstetrics, Diak Klinikum Schwaebisch Hall, Diakoniestrasse 10, 74523 Schwaebisch Hall, Germany
| | - Karen Greif
- Institute of Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstraße 8, 72076 Tuebingen, Germany
| | - Annette Staebler
- Institute of Pathology and Neuropathology, University Hospital Tuebingen, Liebermeisterstraße 8, 72076 Tuebingen, Germany
| | - Felix Neis
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Katharina Rall
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Bernhard Kraemer
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
| | - Stefan Kommoss
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
- Department of Gynecology and Obstetrics, Diak Klinikum Schwaebisch Hall, Diakoniestrasse 10, 74523 Schwaebisch Hall, Germany
| | - Jürgen Andress
- Department of Gynecology and Obstetrics, University Hospital Tuebingen, Calwerstrasse 7, 72076 Tuebingen, Germany
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Ito H, Yokoyama Y, Kyo S, Mandai M, Kosaka K, Kobayashi H, Miyagi E, Onuki M, Matsumoto K, Matsumura N, Umemura K, Ishikawa H, Isaka K. Interim analysis of robot-assisted radical hysterectomy in Japan: a multicenter, prospective interventional single-arm clinical trial. BMC Cancer 2024; 24:1360. [PMID: 39511580 PMCID: PMC11542374 DOI: 10.1186/s12885-024-13090-z] [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: 04/21/2024] [Accepted: 10/23/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVE To investigate the efficacy and safety of robot-assisted radical hysterectomy (RARH) as a minimally invasive procedure in patients with cervical cancer that is curable by surgery. MATERIALS AND METHODS This study was a multicenter, open-label, single-arm clinical trial. The short-term outcome of open radical hysterectomy was used as the historical control. The primary endpoint was successful surgery with minimal blood loss (300 mL or less) and negative surgical margins. Secondary endpoints included surgical outcomes, recurrence-free survival (RFS), and overall survival (OS) rates. RESULTS Overall, 101 cases were enrolled in this study at 10 participating medical institutions and 100 underwent RARH. Among these cases, 89 met the primary endpoint, exceeding the threshold of 0.75 set by the lower limit. At 2 years postoperatively, 17 cases had recurrences, 4 were classified as International federation of Obstetrics and Gynecology Stage IB1 or lower, while 13 as IB2 or higher. There were three deaths, including one in Stage IB1 and two in Stage IIB in the second postoperative year, all of which had lymph node metastasis. The oncological outcomes for all cases showed RFS and OS rates of 82.7% and 96.9%, respectively, over a median observation period of 37 months. For cases with Stage IB1, RFS and OS were 94.1% and 98.5%, respectively. CONCLUSION RARH demonstrated a significant reduction in blood loss while ensuring radicality, indicating the safety and efficacy of this procedure compared to conventional RH. Although it is conceivable that the results of this oncological analysis could change, as the data collection has not been fully completed, we plan to further evaluate the oncologic outcomes of RARH in future studies. TRIAL REGISTRATION UMIN-CTR: UMIN000022278, registered on 11th May 2016.
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Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Hospital, Hirosaki, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology, Kyoto University Hospital, Kyoto, Japan
| | - Kenzo Kosaka
- Department of Obstetrics and Gynecology, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Kagoshima University Hospital, Kagoshima, Japan
| | - Etsuko Miyagi
- Department of Obstetrics and Gynecology, Yokohama City University Hospital, Yokohama, Japan
| | - Mamiko Onuki
- Department of Obstetrics and Gynecology, Showa University of School of Medicine, Tokyo, Japan
| | - Koji Matsumoto
- Department of Obstetrics and Gynecology, Showa University of School of Medicine, Tokyo, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Hospital, Osaka, Japan
| | - Kota Umemura
- Department of Obstetrics and Gynecology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Cancer Prevention, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Isaka
- The Robot Center, Tokyo International Ohori Hospital, 4-8-40, Shimorenjaku, Mitaka City, Tokyo, 181-0013, Japan.
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Wang TN, Woelfel IA, Huang E, Pieper H, Meara MP, Chen X(P. Behind the pattern: General surgery residsent autonomy in robotic surgery. Heliyon 2024; 10:e31691. [PMID: 38841510 PMCID: PMC11152925 DOI: 10.1016/j.heliyon.2024.e31691] [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: 06/13/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
Objective Robotic surgery is increasingly utilized and common in general surgery training programs. This study sought to better understand the factors that influence resident operative autonomy in robotic surgery. We hypothesized that resident seniority, surgeon work experience, surgeon robotic-assisted surgery (RAS) case volume, and procedure type influence general surgery residents' opportunities for autonomy in RAS as measured by percentage of resident individual console time (ICT). Methods General surgery resident ICT data for robotic cholecystectomy (RC), inguinal hernia (RIH), and ventral hernia (RVH) operations performed on the dual-console Da Vinci surgical robotic system between July 2019 and June 2021 were extracted. Cases with postgraduate year (PGY) 2-5 residents participating as a console surgeon were included. A sequential explanatory mixed-methods approach was undertaken to explore the ICT results and we conducted secondary qualitative interviews with surgeons. Descriptive statistics and thematic analysis were applied. Results Resident ICT data from 420 robotic cases (IH 200, RC 121, and VH 99) performed by 20 junior residents (PGY2-3), 18 senior residents (PGY4-5), and 9 attending surgeons were extracted. The average ICT per case was 26.8 % for junior residents and 42.4 % for senior residents. Compared to early-career surgeons, surgeons with over 10 years' work experience gave less ICT to junior (18.2 % vs. 32.0 %) and senior residents (33.9 % vs. 56.6 %) respectively. Surgeons' RAS case volume had no correlation with resident ICT (r = 0.003, p = 0.0003). On average, residents had the most ICT in RC (45.8 %), followed by RIH (36.7 %) and RVH (28.6 %). Interviews with surgeons revealed two potential reasons for these resident ICT patterns: 1) Surgeon assessment of resident training year/experience influenced decisions to grant ICT; 2) Surgeons' perceived operative time pressure inversely affected resident ICT. Conclusions This study suggests resident ICT/autonomy in RC, RIH, and RVH are influenced by resident seniority level, surgeon work experience, and procedure type, but not related to surgeon RAS case volume. Design and implementation of an effective robotic training program must consider the external pressures at conflict with increased resident operative autonomy and seek to mitigate them.
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Affiliation(s)
- Theresa N. Wang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Ingrid A. Woelfel
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Emily Huang
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Heidi Pieper
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
| | - Michael P. Meara
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, OH, USA
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Sickinghe A, Nobbenhuis M, Nelissen E, Heath O, Ind T. Proficiency-based progression training in robot-assisted laparoscopy for endometrial cancer: peri-operative and survival outcomes from an observational cohort study. Front Med (Lausanne) 2024; 11:1370836. [PMID: 38903811 PMCID: PMC11188306 DOI: 10.3389/fmed.2024.1370836] [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: 01/15/2024] [Accepted: 05/06/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Over the last decade there has been a transition from traditional laparoscopy to robotic surgery for the treatment of endometrial cancer. A number of gynecological oncology surgical fellowship programmes have adopted robot-assisted laparoscopy, but the effect of training on complications and survival has not been evaluated. Our aim was to assess the impact of a proficiency-based progression training curriculum in robot-assisted laparoscopy on peri-operative and survival outcomes for endometrial cancer. Methods This is an observational cohort study performed in a tertiary referral and subspecialty training center. Women with primary endometrial cancer treated with robot-assisted laparoscopic surgery between 2015 and 2022 were included. Surgery would normally include a hysterectomy and salpingo-oophorectomy with some form of pelvic lymph node dissection (sentinel lymph nodes or lymphadenectomy). Training was provided according to a training curriculum which involves step-wise progression of the trainee based on proficiency to perform a certain surgical technique. Training cases were identified pre-operatively by consultant surgeons based on clinical factors. Case complexity matched the experience of the trainee. Main outcome measures were intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and 5-year disease-free and disease-specific survival for training versus non-training cases. Mann-Witney U, Pearson's chi-squared, multivariable regression, Kaplan-Meier and Cox proportional hazard analyses were performed to assess the effect of proficiency-based progression training on peri-operative and survival outcomes. Results Training cases had a lower BMI than non-training cases (30 versus 32 kg/m2, p = 0.013), but were comparable in age, performance status and comorbidities. Training had no influence on intra- and post-operative complications, blood transfusions, readmissions < 30 days, return to theater rates and median 5-year disease-free and disease-specific survival. Operating time was longer in training cases (161 versus 137 min, p = < 0.001). The range of estimated blood loss was smaller in training cases. Conversion rates, critical care unit-admissions and lymphoedema rates were comparable. Discussion Proficiency-based progression training can be used safely to teach robot-assisted laparoscopic surgery for women with endometrial cancer. Prospective trails are needed to further investigate the influence of distinct parts of robot-assisted laparoscopic surgery performed by a trainee on endometrial cancer outcomes.
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Affiliation(s)
- Ariane Sickinghe
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
- Faculty of Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marielle Nobbenhuis
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Ellen Nelissen
- Department of Gynecological Oncology, Royal United Hospitals, Bath, United Kingdom
| | - Owen Heath
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Thomas Ind
- Department of Gynecological Oncology, Royal Marsden Hospital, London, United Kingdom
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Ikebuchi A, Komatsu H, Yamamoto K, Okawa M, Hikino K, Iida Y, Hosokawa M, Sawada M, Kudoh A, Sato S, Harada T, Taniguchi F. Outcome of robot-assisted surgery for stage IA endometrial cancer compared to open and laparoscopic surgeries: a retrospective study at a single institution. J Robot Surg 2024; 18:133. [PMID: 38520654 DOI: 10.1007/s11701-024-01897-8] [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: 01/23/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
Few studies have compared the efficacy of robot-assisted, laparoscopic, and open surgeries for endometrial cancer. When considering the position of robotic surgery in Japan, it was necessary to determine whether it was effective or not. We aimed to compare the efficacy and safety of these three types of surgeries for early-stage endometrial cancer. In total, 175 patients with endometrial cancer of preoperative stage IA, who had undergone laparotomic (n = 80), laparoscopic (n = 40), or robot-assisted (n = 55) modified radical hysterectomy at our hospital from 2010 to 2022, were included; surgical outcomes, perioperative complications, and prognoses were compared. Total operative and console times for robot-assisted surgery between patients who did or did not undergo pelvic lymphadenectomy were assessed. The robot-assisted group had the shortest total operative time. The estimated blood loss was lower in the laparoscopic and robot-assisted groups than in the laparotomy group. In advanced postoperative stage IA cases, there were no differences in progression-free and overall survival among the three groups. In the robot-assisted group, the operative time decreased as the number of operations increased; the learning curve was reached after 10 cases each of patients with and without pelvic lymphadenectomy. The frequency of perioperative complications of Clavien-Dindo classification Grade 1 or higher was the lowest in the robot-assisted group (p = 0.02). There were no complications of Clavien-Dindo classification Grade 2 or higher in the robot-assisted group. Robot-assisted surgery for stage IA endometrial cancer, a minimally invasive procedure, has fewer operative times and complications than those of laparoscopic and open surgeries in a single institution in Japan.
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Affiliation(s)
- Ai Ikebuchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan.
| | - Koji Yamamoto
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Masayo Okawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Kohei Hikino
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Yuki Iida
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Masayo Hosokawa
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Mayumi Sawada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Akiko Kudoh
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Shinya Sato
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Tasuku Harada
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
| | - Fuminori Taniguchi
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, 36-1 Nishicho, Yonago, Tottori Prefecture, 683-8504, Japan
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10
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Latifah HM, Khan MA, Nadreen F, Latifah A, Asaad A, Baradwan S. The da Vinci robotic surgery system for the management of endometrial cancer: a single-center experience. J Robot Surg 2024; 18:89. [PMID: 38386227 DOI: 10.1007/s11701-024-01845-6] [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: 12/03/2023] [Accepted: 01/21/2024] [Indexed: 02/23/2024]
Abstract
The aim of this study was to report our single-center experience of the da Vinci robotic surgery system in the management of endometrial cancer (EC) patients during 2019-2023. We descriptively summarized the preoperative, intraoperative, and postoperative outcomes. Moreover, we conducted subgroup analyses based on obesity (BMI ≥ 30 kg/m2) and the intraoperative use of indocyanine green dye (ICG). Overall, 100 patients were analyzed. Eighty-five patients (85%) were obese. The mean operative time and estimated blood loss (EBL) were 240.84 ± 70.08 min (range: 110-720) and 104.2 ± 80.3 ml (range: 20-500), respectively. The mean number of retrieved pelvic LNs was 3.01 ± 3.06 (range: 0-15). The use of ICG was employed in 58 (58%). Only a single patient (1%) underwent conversion to laparotomy. Besides, only three (3%) patients experienced vaginal laceration intraoperatively, respectively. The mean hospital stay was 1.34 ± 0.69 days (range: 1-5). No patient experienced postoperative complications. Most tumors had endometrioid histology (82%), grade-1 tumor (49%), and stage-1A disease (67%). At 3-year follow-up, only two patients (2%) developed recurrence. Patients who received the ICG had significantly lower operative time (225.86 vs. 261.52 min, p = 0.011), estimated blood loss (90 vs. 123.81 ml, p = 0.037), and hospital stay (1.12 vs. 1.64 days, p < 0.001) compared with patients who did not receive it. However, there was no significant difference between both groups regarding the number of retrieved pelvic LNs. Obesity had no significant impact on the rates of intraoperative complications, postoperative complications, and 3-year recurrence incidence. In conclusion, robotic surgery was technically feasible and safe. The use of ICG was statistically linked to favorable outcomes, in terms of decreased operative time, EBL, and hospital stay. Obesity did not impact the perioperative surgical outcomes.
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Affiliation(s)
- Hassan M Latifah
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mahmoud Anis Khan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Farah Nadreen
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Alanoud Asaad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
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11
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Baeten IGT, Hoogendam JP, Schreuder HWR, Jürgenliemk-Schulz IM, Gerestein CG, Zweemer RP. Introducing a novice surgeon to an experienced robotic gynaecological oncology team: An observational cohort study on the impact of a structured curriculum on outcomes of cervical cancer surgery. Gynecol Oncol 2023; 178:153-160. [PMID: 37865051 DOI: 10.1016/j.ygyno.2023.10.008] [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: 05/26/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE To evaluate the effect on patient outcomes when introducing a novice robotic surgeon, trained in accordance with a structured learning curriculum, to an experienced robotic surgery team treating cervical cancer patients. METHODS Patients with early-stage cervical cancer who were treated with primary robot-assisted surgery between 2007 and 2019 were retrospectively included. In addition to the 165 patients included in a former analysis, we included a further 61 consecutively treated patients and divided all 226 patients over three groups: early learning phase of 61 procedures without structured training (group 1), experienced phase of 104 procedures (group 2), and the 61 procedures during introduction of a novice with structured training (group 3). Risk-adjusted cumulative sum (RA-CUSUM) analysis was performed to assess the learning curve effect. Patient outcomes between the groups were compared. RESULTS Based on RA-CUSUM analysis, no learning curve effect was observed for group 3. Regarding surgical outcomes, mean operation time in group 3 was significantly shorter than group 1 (p < 0.001) and similar to group 2 (p = 0.96). Proportions of intraoperative and postoperative adverse events in group 3 were not significantly different from the experienced group (group 2). Regarding oncological outcomes, the 5-year disease-free survival, disease-specific survival, and overall survival in group 3 were not significantly different from the experienced group. CONCLUSIONS Introducing a novice robotic surgeon, who was trained in accordance with a structured learning curriculum, resulted in similar patient outcomes as by experienced surgeons suggesting novices can progress through a learning phase without compromising outcomes of cervical cancer patients.
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Affiliation(s)
- Ilse G T Baeten
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - Jacob P Hoogendam
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Henk W R Schreuder
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ina M Jürgenliemk-Schulz
- Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Cornelis G Gerestein
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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12
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Huang J, Tan Z, Wu W, Wu X, Liu L, Li C. Effect of robotic versus laparoscopic surgery on postoperative wound infection in patients with cervical cancer: A meta-analysis. Int Wound J 2023; 21:e14437. [PMID: 37852784 PMCID: PMC10828729 DOI: 10.1111/iwj.14437] [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: 09/11/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
The objective of this research is to evaluate the risk of postoperative infection and other risks associated with robotic radical hysterectomy (RRH) compared with laparoscopic radical hysterectomy (LRH). Recent studies on RRH versus LRH have not been conclusive for cervical carcinoma. Our group attempted to use meta-analyses to evaluate the effects of both RRH and LRH on postoperative outcomes in order to make sure that the best operative method was used to prevent wound infections. We looked up Cochrane Library and published databases for this research and found 594 findings. Articles were screened by title and abstract and then carefully examined for inclusion and exclusion criteria. Data extraction was performed independently by two researchers. Comparison studies were used to describe the incidence of wound complications after surgery. The publication bias was assessed using Egger regression correlation analysis. There were six trials eligible for inclusion, of which 491 RRH and 807 LRH. Depending on surgery for cervical carcinoma, it is true that there is a difference in the way that surgery affects the postoperative complications. Our analysis demonstrated that the use of robotic operation can decrease the amount of blood loss during operation as compared with routine laparoscopy (MD, -77.69; 95% CI, -132.08, -23.30; p = 0.005). However, there were no statistical differences in the incidence of postoperative wound infections (OR, 0.54; 95% CI, 0.25, 1.19; p = 0.13) and intraoperative operative time (MD, 13.01; 95% CI, -41.38, 67.41; p = 0.64) among the two procedures. There was no statistically significant difference between these two groups of patients with severe postoperative complications. Unlike other research, the findings of this meta-analysis are not consistent with the findings of the present study, which suggest that robotic operations cannot lower the rate of postoperative wound infections. However, because of the limitations and the retrospective character of the trials covered, these findings should be interpreted with care and more extensive research is required.
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Affiliation(s)
- Jin Huang
- Medical School of Yangtze UniversityJingzhouChina
| | - Zhe Tan
- Department of Obstetrics and GynaecologyThe National Hospital of Enshi Tujia and Miao Autonomous PrefectureEnshiChina
| | - Wenyue Wu
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Xiuqian Wu
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
| | - Lian Liu
- Medical School of Yangtze UniversityJingzhouChina
| | - Chunlin Li
- Intervention Therapy DepartmentCancer Hospital of Shantou University Medical CollegeShantouChina
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13
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Komatsu H, Hiraike O, Fukuhara R, Yokoyama Y, Takahashi N, Nishi H, Baba T, Fujii T, Kitawaki J, Kobayashi H, Mandai M. Is there a need for a technical certification system for gynecological robotic surgery? Questionnaire survey of members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy. J Robot Surg 2023; 17:1125-1131. [PMID: 36617623 DOI: 10.1007/s11701-022-01520-8] [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: 04/23/2022] [Accepted: 12/31/2022] [Indexed: 01/10/2023]
Abstract
The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) introduced a system for the certification of laparoscopic surgeons in 2002 and a system for the certification of facilities in 2014. We examined the opinions of the members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) regarding the necessity of a certification training system and a technical certification system for robotic surgery skills in Japan. Members of the JSGOE were surveyed with two questionnaires. Overall, 870 and 519 participants responded to the first and second questionnaires, respectively. Half of the respondents indicated that both systems were necessary. The breakdown by age and qualifications showed that this was especially true for the younger generation and respondents with more experience with robotic surgery. Overall, 40% of the respondents judged that a certification system for robotic surgery alone (with or without certification in laparoscopic surgery but with a requirement of experience in laparoscopic surgery) would be necessary. The opinions of the JSGOE members on making a certification system for robotic surgery were split into two clear-cut camps. Thus, we must further seek the extent of public demand for using a public survey so that a final decision can be made on whether to establish this system.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Obstetrics and Gynecology, Tottori University School of Medicine, Tottori, Japan
| | - Osamu Hiraike
- Department of Obstetrics and Gynecology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Rie Fukuhara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan.
| | - Nobutaka Takahashi
- Department of Gynecology, Shizuoka Cancer Center, Sunto-Gun, Shizuoka, Japan
| | - Hirotaka Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo, Japan
| | - Tsukasa Baba
- Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Iwate, Japan
| | - Takuma Fujii
- Department of Obstetrics and Gynecology, School of Medicine, Fujita Health University, 1-98, Dengakugakubo, Toyoake, Aichi, Japan
| | - Jo Kitawaki
- Department of Gynecology and Obstetrics, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Kobayashi
- Department of Gynecology and Obstetrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
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14
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Ito H, Moritake T, Isaka K. Does the use of a uterine manipulator in robotic surgery for early‐stage endometrial cancer affect oncological outcomes? Int J Med Robot 2022; 18:e2443. [DOI: 10.1002/rcs.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/18/2022] [Accepted: 07/17/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroe Ito
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
| | - Tetsuya Moritake
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
- Department of Obstetrics and Gynrcology Sugawara Hospital Saitama Japan
| | - Keiichi Isaka
- Department of Obstetrics and Gynecology Tokyo Medical University Hospital Shinjuku‐ku Japan
- Robotic Surgery Center Tokyo International Ohori Hospital Mitaka Japan
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15
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Lee YJ, Lee DE, Oh HR, Ha HI, Lim MC. Learning curve analysis of multiport robot-assisted hysterectomy. Arch Gynecol Obstet 2022; 306:1555-1561. [PMID: 35767099 DOI: 10.1007/s00404-022-06655-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the surgical outcomes and learning curve of multiport robot-assisted hysterectomy. METHODS Eighty-eight patients were identified who underwent multiport robot-assisted surgery for hysterectomy. A retrospective analysis was performed. The cumulative summation technique (CUSUM) was used to investigate the learning curve in surgical proficiency by analyzing total operative, docking, and console times. RESULTS The patients' median age was 51 years. In addition, the median operative time was 120.5 min (range 56-344 min). The most common indication for surgery was myoma (33.0%). The median estimated blood loss was 30 mL (range 5-200 mL). There was no conversion to laparoscopic or open surgery. No transfusion was required, and only one complication including umbilical incisional hernia was reported. A tendency of decline in total operative time following the first 23 cases was found. The CUSUM graph for total operative time indicated the generation of three distinct performance phases: learning (n = 23), competence (n = 36), and mastery (n = 29). The median docking time was 3 min (range 1-10 min) and median console time was 70 min (range 24-298 min). CONCLUSION The multiport robot-assisted surgery is an easy and safe procedure with minimal postoperative complications and can be quickly learned. The learning curve was 23 cases to significantly decrease the operative time.
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Affiliation(s)
- Yeon Jee Lee
- Center for Gynecologic Cancer, National Cancer Center, Research Institute and Hospital, Goyang, South Korea
| | - Dong-Eun Lee
- National Cancer Center, Biostatistics Collaboration Team, Research Institute, Goyang, South Korea
| | - Hye Rim Oh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeong In Ha
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Research Institute and Hospital, Goyang, South Korea.
- Rare and Pediatric Cancer Branch and Immuno-Oncology Branch, Division of Rare and Refractory Cancer, Research Institute and Center for Clinical Trial, Hospital, National Cancer Center, Goyang, South Korea.
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
- National Cancer Center, Center for Gynecologic Cancer and Division of Rare and Refractory Cancer, Research Institute and Hospital, 323, Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
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16
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Di Donna MC, Giallombardo V, Lo Balbo G, Cucinella G, Sozzi G, Capozzi VA, Abbate A, Laganà AS, Garzon S, Chiantera V. Conventional Laparoscopy versus Robotic-Assisted Aortic Lymph-Nodal Staging for Locally Advanced Cervical Cancer: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11123332. [PMID: 35743403 PMCID: PMC9224749 DOI: 10.3390/jcm11123332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 02/01/2023] Open
Abstract
Aortic lymph node metastases are a relative common finding in locally advanced cervical cancer. Minimally invasive surgery is the preferred approach to perform para-aortic lymph nodal staging to reduce complications, hospital stay, and the time to primary treatment. This meta-analysis (CRD42022335095) aimed to compare the surgical outcomes of the two most advanced approaches for the aortic staging procedure: conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RAL). The meta-analysis was conducted according to the PRISMA guideline. The search string included the following keywords: "Laparoscopy" (MeSH Unique ID: D010535), "Robotic Surgical Procedures" (MeSH Unique ID: D065287), "Lymph Node Excision" (MeSH Unique ID: D008197) and "Aorta" (MeSH Unique ID: D001011), and "Uterine Cervical Neoplasms" (MeSH Unique ID: D002583). A total of 1324 patients were included in the analysis. Overall, 1200 patients were included in the CL group and 124 patients in the RAL group. Estimated blood loss was significantly higher in CL compared with RAL (p = 0.02), whereas hospital stay was longer in RAL compared with CL (p = 0.02). We did not find significant difference for all the other parameters, including operative time, intra- and postoperative complication rate, and number of lymph nodes excised. Based on our data analysis, both CL and RAL are valid options for para-aortic staging lymphadenectomy in locally advanced cervical cancer.
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Affiliation(s)
- Mariano Catello Di Donna
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy
| | - Vincenzo Giallombardo
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giuseppina Lo Balbo
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giuseppe Cucinella
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Giulio Sozzi
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Vito Andrea Capozzi
- Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy;
| | - Antonino Abbate
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
- Correspondence:
| | - Simone Garzon
- Department of Obstetrics and Gynecology, AOUI Verona, University of Verona, 37126 Verona, Italy;
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, 90127 Palermo, Italy; (M.C.D.D.); (V.G.); (G.L.B.); (G.C.); (G.S.); (A.A.); (V.C.)
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy
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17
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Gota T, Tomio K, Kurose T, Saito R, Nara R, Kin S, Hoshiba M, Ogata Y, Nakanishi M, Takamoto M, Sadatsuki M, Oishi H. The current status of robotic surgery for endometrial cancer in Japan. Glob Health Med 2022; 4:21-25. [PMID: 35291204 PMCID: PMC8884040 DOI: 10.35772/ghm.2021.01077] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/24/2021] [Accepted: 10/01/2021] [Indexed: 06/10/2023]
Abstract
The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) was approved in 2009 by the Japanese Ministry of Health, Labor, and Welfare. In gynecology, robotic surgery for hysterectomy for benign indications and early-stage endometrial cancer has been covered by National Health Insurance since 2018. In a context where the da Vinci surgical system has prevailed in urology departments in Japan, gynecological robotic surgery has spread rapidly once it was covered by insurance. Although minimally invasive gynecologic surgery (minimally invasive surgery, or MIS) in Japan has a specific context, there are several problems with its safety, surgeon education, and cost in Japan. To maximize the many advantages of robotic surgery, its effectiveness needs to be carefully evaluated and this new technology needs to be safely incorporated in practice.
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Affiliation(s)
- Tomoko Gota
- Address correspondence to:Tomoko Gota, Department of Obstetrics and Gynecology, Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
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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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Gillespie BM, Gillespie J, Boorman RJ, Granqvist K, Stranne J, Erichsen-Andersson A. The Impact of Robotic-Assisted Surgery on Team Performance: A Systematic Mixed Studies Review. HUMAN FACTORS 2021; 63:1352-1379. [PMID: 32613863 DOI: 10.1177/0018720820928624] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The aim of this study is to describe the impact of robotic-assisted surgery on team performance in the operating room. BACKGROUND The introduction of surgical robots has improved the technical performance of surgical procedures but has also contributed to unexpected interactions in surgical teams, leading to new types of errors. METHOD A systematic literature search of Cumulative Index to Nursing and Allied Health Literature, PubMed, ProQuest, Cochrane, Web of Science, PsycINFO, and Scopus databases using key words and MeSH terms was conducted. Screening identified studies employing qualitative and quantitative methods published between January 2000 and September 2019. Two reviewers independently appraised the methodological quality of the articles using the Mixed Methods Appraisal Tool (2018). Discussions were held among authors to examine quality scores of the studies and emergent themes, and agreement was reached through consensus. Themes were derived using inductive content analysis. RESULTS Combined searches identified 1,065 citations. Of these, 19 articles, 16 quantitative and 3 qualitative, were included. Robotic-assisted surgeries included urology, gynecology, cardiac, and general procedures involving surgeons, anesthetists, nurses, and technicians. Three themes emerged: Negotiating the altered physical environs and adapting team communications to manage task and technology; managing the robotic system to optimize workflow efficiency; and technical proficiency depends on experience, team familiarity, and case complexity. CONCLUSION Inclusion of a robot as a team member adds further complexity to the work of surgery. APPLICATION These review findings will inform training programs specifically designed to optimize teamwork, workflow efficiency, and learning needs.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery & Menzies Institute of Health, Brisbane, QLD, Australia
- Gold Coast Hospital and Health Service, QLD, Australia
| | | | - Rhonda J Boorman
- School of Nursing & Midwifery & Menzies Institute of Health, Brisbane, QLD, Australia
| | - Karin Granqvist
- 3570Sahlgrenska Academy, Institute of Health & Caring Sciences, University of Gothenburg, Sweden
| | - Johan Stranne
- Sahlgrenska University Hospital, Gothenburg, Sweden
- 3570University of Gothenburg, Sweden
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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: 1] [Impact Index Per Article: 0.3] [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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21
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A modified technique to perform para-aortic lymphadenectomy up to the renal vein. Taiwan J Obstet Gynecol 2021; 59:541-545. [PMID: 32653126 DOI: 10.1016/j.tjog.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To investigate the safety and feasibility of our modified technique to perform lymph node excision up to the renal vein in cases of gynecological cancer. MATERIALS AND METHODS 87 patients with endometrial or ovarian neoplasms underwent laparoscopic para-aortic lymphadenectomy (LPAL) up to the left renal vein were enrolled prospectively. During surgery, the surgeon was positioned to the right side of the patient and an additional trocar was introduced into the upper right abdomen. The laparoscopic video screen was placed to the side of the patient's head. Three-fan retractor forceps were used to hold up the duodenum and small bowel. The rest of the procedure was the same as conventional LPAL. RESULTS The median operating time for LPAL was 72 min (range: 40-115 min) and the median estimated blood loss was 45 ml (range: 15-1000 mL). There were two cases of intra-operative vascular injury. The median number of retrieved para-aortic lymph nodes (PALNs) was 18 (range: 10-37). Of the 87 patients, 11 patients had positive PALNs. None of the cases required laparotomy. CONCLUSION Our findings demonstrate that our modified LPAL technique is feasible, reproducible, can achieve good exposure and reduces surgical difficulty.
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22
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Chen AH, Robertson MW. Route of Hysterectomy: Robotic. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Anita H. Chen
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
| | - Matthew W. Robertson
- Department of Medical and Surgical Gynecology, Mayo Clinic, Jacksonville, Florida, USA
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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: 1.2] [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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The shifting trends towards a robotically-assisted surgical interface: Clinical and financial implications. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Aiko K, Kanno K, Yanai S, Masuda S, Yasui M, Ichikawa F, Teishikata Y, Shirane T, Yoshino Y, Sakate S, Sawada M, Shirane A, Ota Y, Andou M. Short-term outcomes of robot-assisted versus conventional laparoscopic surgery for early-stage endometrial cancer: A retrospective, single-center study. J Obstet Gynaecol Res 2020; 46:1157-1164. [PMID: 32410374 DOI: 10.1111/jog.14293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/30/2020] [Accepted: 04/19/2020] [Indexed: 11/29/2022]
Abstract
AIM We compared the short-term outcomes between conventional laparoscopic surgery (CLS) and robot-assisted surgery (RAS) to assess the technical feasibility of the latter for early-stage endometrial cancer. METHODS We retrospectively compared the perioperative outcomes between two groups of 223 patients (CLS group, n = 102; RAS group, n = 121) with early-stage endometrial cancer. Surgical procedures included hysterectomy, bilateral salpingo-oophorectomy and retroperitoneal lymphadenectomy. We analyzed the data from intrapelvic surgery alone because para-aortic lymphadenectomy was performed via conventional endoscopic extraperitoneal approach without robot for both groups. RESULTS No differences were identified in patients' age and body mass index. The mean operative time was 133 ± 28 versus 178 ± 41 min (P < 0.01), mean blood loss was 196 ± 153 versus 237 ± 146 mL (P = 0.047), mean length of postoperative hospital stay was 9 ± 4 versus 8 ± 3 days (P = 0.01) and mean rate of perioperative complications of Clavien-Dindo grade III or higher was 2.0 versus 3.4% (P = 0.53) for the CLS versus RAS groups, respectively. There was no significant difference in the number of resected lymph nodes. CONCLUSION The operative time was significantly longer and blood loss was significantly greater in the RAS group than in the CLS group, without a significant difference in the number of resected lymph nodes. These differences are within an acceptable clinical range, showing that RAS is feasible and safe for early-stage endometrial cancer, providing short-term outcomes comparable to those of conventional surgery. Future studies are warranted to compare the long-term oncological outcomes by extending the observation period and including para-aortic lymphadenectomy data.
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Affiliation(s)
- Kiyoshi Aiko
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Kiyoshi Kanno
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Shiori Yanai
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Sayaka Masuda
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Michiru Yasui
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Fuyuki Ichikawa
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Yasuhiro Teishikata
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Terumi Shirane
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Yasunori Yoshino
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Shintaro Sakate
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Mari Sawada
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Akira Shirane
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Yoshiaki Ota
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
| | - Masaaki Andou
- Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan
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Marra AR, Puig-Asensio M, Edmond MB, Schweizer ML, Bender D. Infectious complications of laparoscopic and robotic hysterectomy: a systematic literature review and meta-analysis. Int J Gynecol Cancer 2020; 29:518-530. [PMID: 30833440 DOI: 10.1136/ijgc-2018-000098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE We performed a systematic review of the literature and meta-analysis of the infectious complications of hysterectomy, comparing robotic-assisted hysterectomy to conventional laparoscopic-assisted hysterectomy. METHODS We searched PubMed, CINAHL, CDSR, and EMBASE through July 2018 for studies evaluating robotic-assisted hysterectomy, laparoscopic-assisted hysterectomy, and infectious complications. We employed random-effect models to obtain pooled OR estimates. Heterogeneity was evaluated with I2 estimation and the Cochran Q statistic. Pooled ORs were calculated separately based on the reason for hysterectomy (eg, benign uterine diseases, endometrial cancer, and cervical cancer). RESULTS Fifty studies were included in the final review for the meta-analysis with 176 016 patients undergoing hysterectomy. There was no statistically significant difference in the number of infectious complication events between robotic-assisted hysterectomy and laparoscopic-assisted hysterectomy (pooled OR 0.97; 95 % CI 0.74 to 1.28). When we performed a stratified analysis, similar results were found with no statistically significant difference in infectious complications comparing robotic-assisted hysterectomy to laparoscopic-assisted hysterectomy among patients with benign uterine disease (pooled OR 1.10; 95 % CI 0.70 to 1.73), endometrial cancer (pooled OR 0.97; 95 % CI 0.55 to 1.73), or cervical cancer (pooled OR 1.09; 95 % CI 0.60 to 1.97). CONCLUSION In our meta-analysis the rate of infectious complications associated with robotic-assisted hysterectomy was no different than that associated with conventional laparoscopic-assisted hysterectomy.
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Affiliation(s)
- Alexandre R Marra
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Mireia Puig-Asensio
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
| | - Michael B Edmond
- Office of Clinical Quality, Safety and Performance Improvement University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Marin L Schweizer
- Division of General Internal Medicine, Department of Internal Medicine, Carver College of Medicine, Iowa City, Iowa, USA
- The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, Iowa, USA
| | - David Bender
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Cacciola TP, Martino M. Simulation in Obstetrics and Gynecology. COMPREHENSIVE HEALTHCARE SIMULATION: SURGERY AND SURGICAL SUBSPECIALTIES 2019. [DOI: 10.1007/978-3-319-98276-2_30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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A systematic review of the learning curve in robotic surgery: range and heterogeneity. Surg Endosc 2018; 33:353-365. [DOI: 10.1007/s00464-018-6473-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/20/2018] [Indexed: 12/18/2022]
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Silva ASE, de Carvalho JPM, Anton C, Fernandes RP, Baracat EC, Carvalho JP. Introduction of robotic surgery for endometrial cancer into a Brazilian cancer service: a randomized trial evaluating perioperative clinical outcomes and costs. Clinics (Sao Paulo) 2018; 73:e522s. [PMID: 30281698 PMCID: PMC6131215 DOI: 10.6061/clinics/2017/e522s] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/04/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcome and costs after the implementation of robotic surgery in the treatment of endometrial cancer, compared to the traditional laparoscopic approach. METHODS In this prospective randomized study from 2015 to 2017, eighty-nine patients with endometrial carcinoma that was clinically restricted to the uterus were randomized in robotic surgery (44 cases) and traditional laparoscopic surgery (45 cases). We compared the number of retrieved lymph nodes, total time of surgery, time of each surgical step, blood loss, length of hospital stay, major and minor complications, conversion rates and costs. RESULTS The ages of the patients ranged from 47 to 69 years. The median body mass index was 31.1 (21.4-54.2) in the robotic surgery arm and 31.6 (22.9-58.6) in the traditional laparoscopic arm. The median tumor sizes were 4.0 (1.5-10.0) cm and 4.0 (0.0-9.0) cm in the robotic and traditional laparoscopic surgery groups, respectively. The median total numbers of lymph nodes retrieved were 19 (3-61) and 20 (4-34) in the robotic and traditional laparoscopic surgery arms, respectively. The median total duration of the whole procedure was 319.5 (170-520) minutes in the robotic surgery arm and 248 (85-465) minutes in the traditional laparoscopic arm. Eight major complications were registered in each group. The total cost was 41% higher for robotic surgery than for traditional laparoscopic surgery. CONCLUSIONS Robotic surgery for endometrial cancer presented equivalent perioperative morbidity to that of traditional laparoscopic surgery. The duration and total cost of robotic surgery were higher than those of traditional laparoscopic surgery.
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Affiliation(s)
- Alexandre Silva e Silva
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - João Paulo Mancusi de Carvalho
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Cristina Anton
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rodrigo Pinto Fernandes
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Jesus Paula Carvalho
- Disciplina de Ginecologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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Anesthesia for Robot Assisted Gynecological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ziogas IA, Tsoulfas G. Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma. World J Gastrointest Surg 2017; 9:233-245. [PMID: 29359029 PMCID: PMC5752958 DOI: 10.4240/wjgs.v9.i12.233] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/04/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery < 5 cm, especially in segments II through VI, while according to the consensus laparoscopic major hepatectomy should only be performed by surgeons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.
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Affiliation(s)
- Ioannis A Ziogas
- Medical School, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
| | - Georgios Tsoulfas
- Associate Professor of Surgery, 1st Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki 54453, Greece
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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: 40] [Impact Index Per Article: 5.0] [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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Nicklin J. The future of robotic-assisted laparoscopic gynaecologic surgery in Australia - A time and a place for everything. Aust N Z J Obstet Gynaecol 2017; 57:493-498. [PMID: 28857135 DOI: 10.1111/ajo.12688] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/19/2017] [Indexed: 12/14/2022]
Abstract
There has been a significant increase in minimally invasive surgery in gynaecology over the last 15 years, with approximately only one-third of hysterectomies for benign disease now performed via laparotomy. While robotic surgery offers considerable technical advantages over conventional laparoscopy and is associated with only a modest learning curve, the improvement in clinical outcomes is marginal and there are several disadvantages. There are increased set-up and operating times, the need to accommodate and maintain large sophisticated equipment, and the requirement for additional training. The preeminent issue regarding the place of robotic gynaecological surgery is cost. How this is addressed and contained will ultimately determine uptake in Australia. From the published literature to date, robotic surgery compared with conventional laparoscopic surgery is associated with marginal improvements in clinical outcomes for benign hysterectomy and endometrial cancer surgery, but little improvement for other benign gynaecological surgery or for cervical cancer surgery. Robotic surgery probably does improve clinical outcomes in obese and morbidly obese patients and is associated with improved ergonomics for the surgeon. It is likely that there will be continued substantial improvements in robotic surgical platforms into the foreseeable future and that robotic surgery will play an increasingly important role in gynaecological surgery in Australia.
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Affiliation(s)
- James Nicklin
- Queensland Centre for Gynaecological Cancer, Brisbane, Queensland, Australia
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Park JY, Nam JH. Role of robotic surgery in cervical malignancy. Best Pract Res Clin Obstet Gynaecol 2017; 45:60-73. [PMID: 28533153 DOI: 10.1016/j.bpobgyn.2017.03.009] [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: 02/27/2017] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
Surgical treatment is the mainstay of the management of early-stage cervical cancer. Abdominal radical hysterectomy and trachelectomy have long been the standard surgical approach to early-stage cervical cancer, achieving excellent survival outcomes. Recently, laparoscopic radical hysterectomy and trachelectomy have become the preferred alternative to abdominal surgery because laparoscopic approaches lead to better surgical outcomes without compromising survival outcomes. Since the robotic surgery platform was approved for the use of gynaecologic surgery in 2005, robotic radical hysterectomy and trachelectomy have been increasingly used in the surgical management of early-stage cervical cancer. However, the role of robotic surgery is poorly defined. This review examines the role of robotic surgery in the surgical management of cervical cancer by comparing the published data on its use with those of abdominal and laparoscopic surgeries.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
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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: 2.3] [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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Chen SH, Li ZA, Huang R, Xue HQ. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: A meta-analysis. Taiwan J Obstet Gynecol 2017; 55:488-94. [PMID: 27590368 DOI: 10.1016/j.tjog.2016.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2016] [Indexed: 10/21/2022] Open
Abstract
This meta-analysis broadly compared the safety and efficacy of robot-assisted laparoscopy (RAL) with that of conventional laparoscopy (CL) for endometrial cancer staging. The advantages of RAL were evaluated through the outcomes in terms of conversion rates, complications, length of operation, blood loss, number of lymph nodes harvested, and length of hospitalization. Three electronic databases (PubMed, MEDLINE, and EmBASE) were searched to identify eligible studies. We selected all retrospective studies documenting a comparison between RAL and CL for endometrial cancer staging between 2005 and 2015, and tallied with meta-analyses criteria. Only studies published in English were included in this analysis. The outcomes of the extracted data were pooled and estimated by the Review Manager version 5.1 software. Seventeen studies met the eligibility criteria. Among the 2105 patients reported, 912 underwent RAL and the other 1193 underwent CL for endometrial cancer staging. Compared with CL, RAL had lower conversion rates [risk ratio, 0.4; 95% confidence interval (CI), 0.25-0.64; p = 0.0002]. Its complications were also less than that of CL (risk ratio, 0.72; 95% CI, 0.56-0.94; p = 0.02). RAL was associated with significantly less intraoperative blood loss (weighted mean difference, -79.2 mL; 95% CI, from -103.43 to -54.97; p < 0.00001) and a shorter length of hospitalization (weighted mean difference, -0.37 days; 95% CI, from -0.57 to -0.17; p = 0.0003). We found no significant differences in the length of operation and number of lymph nodes harvested between the two groups. From our meta-analysis results, RAL is a safe and effective alternative to CL for endometrial cancer staging. Further studies are required to determine potential advantages or disadvantages of RAL.
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Affiliation(s)
- Shao-Hui Chen
- Department of Obstetrics and Gynaecology, Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan City, Shanxi Province, PR China.
| | - Zhao-Ai Li
- Department of Obstetrics and Gynaecology, Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan City, Shanxi Province, PR China
| | - Rui Huang
- Department of Obstetrics and Gynaecology, Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan City, Shanxi Province, PR China
| | - Hui-Qin Xue
- Department of Obstetrics and Gynaecology, Women Health Center of Shanxi, Children's Hospital of Shanxi, Taiyuan City, Shanxi Province, PR China
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Abstract
Minimally invasive hysterectomy via the laparoscopic or vaginal approach is beneficial to patients when compared with laparotomy, but has not been offered in the past to all women because of the technical difficulties and the long learning curve required for laparoscopic hysterectomy. Robotic-assisted hysterectomy for benign indications may allow for a shorter learning curve but does not offer clear advantages over conventional laparoscopic hysterectomy in terms of surgical outcomes. In addition, robotic hysterectomy is invariably associated with increased costs. Nevertheless, this surgical approach has been widely adopted by gynecologic surgeons. The aim of this review is to describe specific indications and patients who may benefit from robotic-assisted hysterectomy. These include hysterectomy for benign conditions in cases with high surgical complexity (such as pelvic adhesive disease and endometriosis), hysterectomy and lymphadenectomy for treatment of endometrial carcinoma, and obese patients. In the future, additional evidence regarding the benefits of single-site robotic hysterectomy may further modify the indications for robotic-assisted hysterectomy.
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Affiliation(s)
- Noam Smorgick
- Departments of Obstetrics and Gynecology, Assaf Harofe Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kristensen SE, Mosgaard BJ, Rosendahl M, Dalsgaard T, Bjørn SF, Frøding LP, Kehlet H, Høgdall CK, Lajer H. Robot-assisted surgery in gynecological oncology: current status and controversies on patient benefits, cost and surgeon conditions - a systematic review. Acta Obstet Gynecol Scand 2017; 96:274-285. [DOI: 10.1111/aogs.13084] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 12/16/2016] [Indexed: 12/26/2022]
Affiliation(s)
| | - Berit J. Mosgaard
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Mikkel Rosendahl
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Tórur Dalsgaard
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Signe F. Bjørn
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Ligita P. Frøding
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Henrik Kehlet
- Section for Surgical Pathophysiology; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Claus K. Høgdall
- Faculty of Medicine; University of Copenhagen Health Science; Copenhagen Denmark
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
| | - Henrik Lajer
- Gynecological Department; The Juliane Marie Center; Rigshospitalet-Copenhagen University Hospital; Copenhagen Denmark
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Robotic and Advanced Laparoscopic Surgical Training in European Gynecological Oncology Trainees. Int J Gynecol Cancer 2017; 27:375-381. [PMID: 28114237 DOI: 10.1097/igc.0000000000000879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Advanced minimal access surgical training is an important component of training in gynecological oncology (GO). Europe-wide data on this topic are lacking. We present data on availability and trainee experience of advanced laparoscopic surgical (ALS) and robotic surgical (RS) training in GO across Europe. METHOD A prospective web-based anonymized survey of European GO trainees was sent to the European Network of Young Gynaecological Oncologists members/trainees. It included sociodemographic information and specific questions pertaining to training experience or satisfaction in laparoscopic and robotic surgery. χ test was used for evaluating categorical variables and Mann-Whitney/Kruskal-Wallis (nonparametric) tests for continuous variables between 2 and more independent groups. RESULTS A total of 113 GO trainees from 29 countries responded. The mean (standard deviation) age was 35.2 (6.1) years, 59.3% were men, 40.7% were women, and 46% were in accredited training posts. The ALS and RS training was offered in only 43% and 23% of institutes respectively, and 54% and 23% of trainees had undergone some form of formal or informal training in ALS and RS respectively. A total of 62.4% felt that RS should be a formal component of GO training programs. A total of 61% and 35% planned to go outside their institute for ALS or RS training respectively. Trainees rating (1-5 scale) of their open surgery and ALS or RS skills (3.3/2.6/1.9) and training experience (3.5/2.8/2.1), respectively, were higher for open surgery than ALS or RS (P < 0.0005). Accredited posts were more likely than nonaccredited posts to offer ALS training (60%/31%, P = 0.002), formal training schedules (27.9%/4.4%, P = 0.003), and use of logbooks (46%/23%, P = 0.035). CONCLUSIONS Training and experience in ALS and RS are poorly rated by GO trainees across Europe, and only few centers offer this. There is an urgent need to expand and harmonize training opportunities for ALS and RS. Most trainees want RS included as a formal component of their training.
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Favre A, Huberlant S, Carbonnel M, Goetgheluck J, Revaux A, Ayoubi JM. Pedagogic Approach in the Surgical Learning: The First Period of "Assistant Surgeon" May Improve the Learning Curve for Laparoscopic Robotic-Assisted Hysterectomy. Front Surg 2016; 3:58. [PMID: 27853733 PMCID: PMC5089967 DOI: 10.3389/fsurg.2016.00058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022] Open
Abstract
Background Hysterectomy is the most frequent surgery done with robotic assistance in the world and has been widely studied since its emergence. The surgical outcomes of the robotic hysterectomy are similar to those obtained with other minimally invasive hysterectomy techniques (laparoscopic and vaginal) and appear as a promising surgical technique in gynecology surgery. The aim of this study was to observe the learning curve of robot-assisted hysterectomy in a French surgical center, and was to evaluate the impact of the surgical mentoring. Methods We retrospectively collected the data from the files of the robot-assisted hysterectomies with the Da Vinci® Surgical System performed between March 2010 and June 2014 at the Foch hospital in Suresnes (France). We first studied the operative time according to the number of cases, independently of the surgeon to determine two periods: the initial learning phase (Phase 1) and the control of surgical skills phase (Phase 2). The phase was defined by mastering the basic surgical tasks. Secondarily, we compared these two periods for operative time, blood losses, body mass index (BMI), days of hospitalizations, and uterine weight. We, finally, studied the difference of the learning curve between an experimented surgeon (S1) who practiced first the robot-assisted hysterectomies and a less experimented surgeon (S2) who first assisted S1 and then operated on his own patients. Results A total of 154 robot-assisted hysterectomies were analyzed. Twenty procedures were necessary to access to the control of surgical skills phase. There was a significant decrease of the operative time between the learning phase (156.8 min) compared to the control of surgical skills phase (125.8 min, p = 0.003). No difference between these two periods for blood losses, BMI, days of hospitalizations and uterine weight was demonstrated. The learning curve of S1 showed 20 procedures to master the robot-assisted hysterectomies with a significant decrease of the operative time, while the learning curve of S2 showed no improvement in operative time with respect to case number. Conclusion Twenty robot-assisted hysterectomies are necessary to achieve control of surgical skills. The companionship to learn robotic surgery seems also promising, by improving the learning phase for this surgical technique.
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Affiliation(s)
- Angeline Favre
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | | | - Marie Carbonnel
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Julie Goetgheluck
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Aurelie Revaux
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
| | - Jean Marc Ayoubi
- Obstetrics and Gynecology Department, Foch Hospital , Suresnes , France
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42
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Foote JR, Valea FA. Robotic surgical training: Where are we? Gynecol Oncol 2016; 143:179-183. [DOI: 10.1016/j.ygyno.2016.05.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/20/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Xie W, Cao D, Yang J, Shen K, Zhao L. Robot-assisted surgery versus conventional laparoscopic surgery for endometrial cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2016; 142:2173-83. [PMID: 27217038 DOI: 10.1007/s00432-016-2180-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 05/09/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE To compare perioperative outcomes between robot-assisted surgery (RAS) and conventional laparoscopic surgery (CLS) for the treatment of endometrial cancer by conducting a meta-analysis. METHODS We searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE up to January 8, 2016. Studies clearly documenting a comparison between RAS and CLS for patients with endometrial cancer were included. The perioperative outcomes of interest included intraoperative visceral injuries, postoperative complications, operation time, estimated blood loss (EBL), blood transfusion, total lymph nodes harvested (TLNH), conversion to laparotomy, and length of hospital stay. The weighted mean difference (WMD) and odds ratio (OR) were pooled with either a fixed-effects or a random-effects model. RESULTS A total of 19 studies were included in the analysis, involving 3056 patients. The pooled analysis showed that RAS was associated with lower EBL (WMD -77.65; 95 % confidence interval [CI] -105.58 to -49.72), lower conversion rate (OR 0.29; 95 % CI 0.18-0.46), and shorter hospital stay (WMD -0.48; 95 % CI -0.70 to -0.26) compared to CLS. The incidence of intraoperative visceral injuries, operation time, transfusion rate, and TLNH showed no significant differences between RAS and CLS. CONCLUSIONS RAS is a feasible and effective surgical approach that may be superior to CLS for the treatment of endometrial cancer, with lower EBL and lower conversion rate. Further prospective randomized trials are required to validate our findings.
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Affiliation(s)
- Weimin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China.
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Lin Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
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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: 5.7] [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
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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: 21] [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.
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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
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Abstract
BACKGROUND Robotic-assisted surgery is a technological advancement, and its use is rapidly expanding into the field of gynecological oncology. However, a paucity of evidence exists to prove its superiority over standard laparoscopy. Its cost is also high and it lacks haptic feedback. METHODS A systematic review of the relevant literature was undertaken to understand the use of robotic-assisted surgery in gynecological oncology. RESULTS Robotic-assisted surgery is being used for select cases of endometrial cancer and has resulted in the increased utilization of minimally invasive surgery for such patients. Use of robotic-assisted surgery among patients who are obese has led to decreased complication rates. Robotic-assisted surgery appears to be more expensive than traditional laparoscopy; however, there are potential cost savings to robotic-assisted surgery, including shorter hospital stays and fewer complications, compared with laparotomy. CONCLUSIONS The gynecological oncology community is rapidly accepting the use of robotic-assisted surgery. Although randomized controlled trials are lacking, the technology appears to be safe and effective, and it has equivalent oncological outcomes in this patient population.
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Affiliation(s)
- Stephen H Bush
- Department of Gynecologic Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Robotic-Assisted Pelvic and High Para-aortic Lymphadenectomy (RPLND) for Endometrial Cancer and Learning Curve. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0058-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Robotic Transperitoneal Infrarenal Para-Aortic Lymphadenectomy With Double Docking: Technique, Learning Curve, and Perioperative Outcomes. J Minim Invasive Gynecol 2016; 23:622-7. [DOI: 10.1016/j.jmig.2016.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
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49
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King JC, Zeh HJ, Zureikat AH, Celebrezze J, Holtzman MP, Stang ML, Tsung A, Bartlett DL, Hogg ME. Safety in Numbers: Progressive Implementation of a Robotics Program in an Academic Surgical Oncology Practice. Surg Innov 2016; 23:407-14. [PMID: 27130645 DOI: 10.1177/1553350616646479] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Robotic-assisted surgery has potential benefits over laparoscopy yet little has been published on the integration of this platform into complex surgical oncology. We describe the outcomes associated with integration of robotics into a large surgical oncology program, focusing on metrics of safety and efficiency. Methods A retrospective review of a prospectively maintained database of robotic procedures from July 2009 to October 2014 identifying trends in volume, operative time, complications, conversion to open, and 90-day mortality. Results Fourteen surgeons performed 1236 cases during the study period: thyroid (246), pancreas/duodenum (458), liver (157), stomach (56), colorectal (129), adrenal (38), cholecystectomy (102), and other (48). There were 38 conversions to open (3.1%), 230 complications (18.6%), and 13 mortalities (1.1%). From 2009 to 2014, operative volume increased (7 cases/month vs 24 cases/month; P < .001) and procedure time decreased (471 ± 166 vs 211 ± 140 minutes; P < .001) with statistically significant decreases for all years except 2014 when volume and time plateaued. Conversion to open decreased (12.1% vs 1.7%; P = .009) and complications decreased (48.5% vs 12.3%; P < .001) despite increasing complexity of cases performed. There were 13 deaths within 90 days (5/13 30-day mortality) and 2 (15.4%) were from palliative surgeries. Conclusions Implementation of a diverse robotic surgical oncology program utilizing multiple surgeons is safe and feasible. As operative volume increased, operative time, complications, and conversions to open decreased and plateaued at approximately 3 years. No unanticipated adverse events attributable to the introduction of this platform were observed.
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Affiliation(s)
- Jonathan C King
- David Geffen School of Medicine at UCLA, Santa Monica, CA, USA
| | - Herbert J Zeh
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amer H Zureikat
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - James Celebrezze
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Michael L Stang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Allan Tsung
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David L Bartlett
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Melissa E Hogg
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Chu LH, Chang WC, Sheu BC. Comparison of the laparoscopic versus conventional open method for surgical staging of endometrial carcinoma. Taiwan J Obstet Gynecol 2016; 55:188-92. [DOI: 10.1016/j.tjog.2016.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2015] [Indexed: 10/21/2022] Open
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