Robot-assisted laparoscopic surgery for cervical cancer

Abstract: Cervical cancer is the third most common cancer in women worldwide and the fourth leading cause of cancer death. In Western countries, it is the 10th most common cause of cancer death. Cervical cancer often affects young women (< 40 years) who have not finished childbearing. Robot assistance is the latest development in laparoscopic surgery. There is one robot commercially available for gynecologic surgery that has been approved by the U.S. Food and Drug Administration in 2005. The robot offers a stable three-dimensional view, downscaling of movements, tremor elimination, and ergonomic working position for the surgeon. This can help the surgeon to overcome some limitations of traditional laparoscopy and offer a laparoscopic approach with its benefits to patients requiring more advanced surgery. Study I: Is it feasible to use the robot to perform laparoscopic radical hysterectomy (RH). Relevant information from 80 women operated with the robot between 2005 and 2008 were analyzed to measure surgical outcome, including short- and long-term (> 1 year) morbidity. There was a steep learning curve for the surgical time, and the adverse events, even though usually mild, decreased with time. There was a relatively high incidence of vaginal dehiscence (6%). The robot has aided the introduction of laparoscopic RH at our center and is a feasible option for the patients. Study II: Do surgical knots tied with the robot have equal tensile strength as knots tied by hand? Four knot formations were tied by four surgeons in the robot and compared with the hand-tied knot recommended by the manufacturer of the thread. One out of four surgeons tied the knots in the robot with equal strength to the hand- tied knots. Strand-to-strand knots performed better than loop-to-strand knot and should therefore be recommended. Study III: Is it possible to perform laparoscopic transabdominal radical trachelectomy aided by the robot with consistent surgical precision? Two quality parameters (cervical length and placement of cerclage) were compared in 12 women operated with the robot with 10 women operated vaginally. The two groups had the same remaining cervical length, but the placement of the cerclage was more precise and consistent in the robot group. Study IV: Is it possible to perform robot-assisted RH with the same hospital cost as with laparotomy? Fifty-one patients operated with open RH were compared with 180 patients operated with robot assistance. The robot was more expensive in the beginning, but after 90 operations (3 years), there was no difference in hospital cost. Study V: Is it oncologically safe to operate women with early cervical cancer with the robot? The oncological outcome for 170 women operated with the robot was compared with FIGO results. This comparison does not raise concerns about oncological outcome following robot-assisted RH for cervical cancer.