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

Jagdishwar GG, Kiranmai G, Vikas Kumar MB, Arun Katari, Kaveri Shaw

Pdf Page Numbers :- 57-64

Jagdishwar GG^1,*, Kiranmai G¹, Vikas Kumar MB¹, Arun Katari¹ and Kaveri Shaw¹

¹Department of Surgical Oncology and Robotic Surgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, AP, India

*Corresponding author: Dr. G. Jagdishwar Gajagowni, MS, M.Ch., Consultant Surgical Oncologist, Department of Surgical Oncology and Robotic Surgery, Krishna Institute of Medical Sciences, Minister Road, Secunderabad - 500003, AP, India, Email: jagadishgdr@yahoo.com.

Received 2 May 2013; Revised 29 May 2013; Accepted 8 June 2013

Citation: Jagdishwar GG, Kiranmai G, Vikas Kumar MB, Arun Katari and Kaveri Shaw. Robotic versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for the treatment of early cervical cancer. J Med Sci Res 2013; 1(2): 57-64. http://dx.doi.org/10.17727/JMSR.2013/1-011

Copyright: © 2013 Jagdishwar GG et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: The aim of this study is to compare the safety, morbidity, intra operative, pathologic and postoperative outcomes of Robotic radical hysterectomy (RRH) to total laparoscopic radical hysterectomy (TLRH) in patients with early stage cervical cancer.

Materials and methods: All the women with newly diagnosed invasive cervical cancer (stage IA1 to IIA), who underwent TLRH or RRH with pelvic lymph node dissection at Krishna Institute of Medical Sciences from June 2010 to February 2013 were analyzed.

Results: Twenty patients underwent TLRH with pelvic lymphadenectomy from June 2010 to September 2011.Sixteen patients underwent RRH with pelvic lymphadenectomy from October 2011 to February 2013. Age, tumor histology, stage, lymphovascular space involvement and nodal status are same for both the groups. No statistical differences were observed in operative time (174 vs. 158 min), estimated blood loss (160 vs. 110 ml), or hospital stay (3.1 vs. 2.8 days). Mean pelvic lymph node count was more in Robotic group. None of the robotic or laparoscopic procedures required conversion to laparotomy. All patients in both groups are alive and free of disease at the time of last follow up.

Conclusions: According to our experience, robotic radical hysterectomy appears to be safe and effective therapeutic procedure for managing early-stage cervical cancer without significant differences when compared to TLRH, with respect to operative time, blood loss, hospital stay. Regarding the oncological outcome, Robotic radical hysterectomy is superior in terms of number of lymph nodes and parametrial bulk; although multicenter randomized clinical trials with longer follow-up are necessary to evaluate the overall oncologic outcome. We appreciate, the intuitive nature of the robotic approach, magnification, dexterity, and flexibility combined with significant reduction in surgeon's fatigue offered by the robotic system will allow more surgeons to use a minimally invasive approach to radical hysterectomy.

Keywords: Laparoscopic; Hysterectomy; Pelvic lymphadenectomy; Cervical cancer