Nerve-Sparing Robotic Radical Hysterectomy for the Beginner in Robotic Surgery

Robotic surgery is considered to be the optimal means of performing nerve-sparing radical hysterectomy (RH) because this procedure requires very precise surgery. Nerve-sparing RH has become increasingly popular in Japan. However, with open surgery the operating field is only visible to the surgeon performing this delicate procedure, which makes it difficult to educate trainee assistants. However, robotic surgery provides an expanded operation field that is visible to the surgeon and assistants, which makes it suitable for teaching purposes. To perform this procedure, it is necessary to become proficient in RH by laparotomy and then to become familiar with the characteristics of robotic surgery. In shifting from laparotomy to robotic surgery, we have found that experience with open surgery does not fully prepare surgeons for the new experiences and discoveries associated with robotic surgery, which may initially be problematic. We here provide clear instructions for the procedure with notes concerning particular potentially problematic aspects.

Robotic radical hysterectomy for early-stage cervical cancer: A systematic literature review

Robotic technology has recently come into widespread use to overcome the limitations of laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. Most comparative studies showed that blood loss and hospital stays for patients undergoing minimally invasive surgery, including robotic procedures, were superior compared to open surgery. Moreover, the survival outcomes of robotic radical hysterectomy were not inferior to open radical hysterectomy. Unexpectedly, the Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized, open-label, noninferiority study that compared minimally invasive radical hysterectomy with open radical hysterectomy, revealed that minimally invasive surgery was associated with a higher risk of recurrence and death compared with open surgery. Strict guidelines for robotic radical hysterectomy for the treatment of early-stage cervical cancer should be established in accordance with objective Korean data. In addition, it is recommended that further studies should be performed on how to avoid the use of uterine manipulators and the dissemination of cancer cells by ensuring a more effective vaginal closure using a standardized approach.

Increased Institutional Surgical Experience in Robot-Assisted Radical Hysterectomy for Early Stage Cervical Cancer Reduces Recurrence Rate: Results from a Nationwide Study

The aim of this study was to evaluate the impact of institutional surgical experience on recurrence following robotic radical hysterectomy (RRH) for early stage cervical cancer. All women in Sweden who underwent an RRH for stage IA2-IB1 cervical cancer at tertiary referral centers from its implementation in December 2005 until June 2017 were identified using a Swedish nationwide register and local hospital registers. Registry data were controlled by a chart review of all women. Recurrence rates and patterns of recurrence were compared between early and late (≤50 vs. >50 procedures) institutional series. Six hundred and thirty-five women were included. Regression analysis identified a lower risk of recurrence with increased experience but without a clear cut off level. Among the 489 women who did not receive adjuvant radio chemotherapy (RC-T), the rate of recurrence was 3.6% in the experienced cohort (>50 procedures) compared to 9.3% in the introductory cohort (p < 0.05). This was also seen in tumors < 2 cm regardless of RC-T (p < 0.05), whereas no difference in recurrence was seen when analyzing all women receiving RC-T. In conclusion, the rate of recurrence following RRH for early stage cervical cancer decreased with increased institutional surgical experience, in tumors < 2 cm and in women who did not receive adjuvant RC-T.