Robotic-Assisted Surgery Found Superior in Gynecologic Oncology

A new study has found that found that robotic radical hysterectomy (RRH) results in lower blood loss and shorter length of stay compared with traditional open radical hysterectomies (ORH) in patients with stage I and II cervical cancer.

Researchers from Brigham and Women's Hospital (BWH, Boston, MA, USA) reviewed and compared intraoperative and postsurgical factors for 16 RRH (using the DaVinci robot) and 32 ORH procedures performed between August 2004 and June 2007. Demographic data, operative data, and short-term outcomes were compared; the groups did not differ significantly in age, body mass index (BMI), stage, or histology.

The researchers found that although the surgeries took longer, patients who underwent RRH had less blood loss compared with those who had ORH procedures. Patients who had an RRH also had shorter hospital stays after the surgery compared with patients who had ORH. There were no intraoperative complications in the RRH group and one ureteral transection in the ORH group. Three RRH patients (18.8%) suffered postoperative complications which included a vaginal cuff infected hematoma, a transient ureterovaginal fistula, and a pelvic lymphocele, in comparison to seven in the ORH group (21.9%) which included three wound infections, two patients with pulmonary emboli, a partial small bowel obstruction with a mesenteric abscess, and a postoperative ileus. The mean number of lymph nodes resected did not differ between RRHs and ORHs. The study was published in the December 2008 issue of the journal Gynecologic Oncology.

"Robotic radical hysterectomy is a new and important method for both surgeons and patients as the entire field of surgery trends toward minimally invasive procedures. In our study, we show that this approach can reduce both blood loss and the length of hospital stay for the patient,” said senior author Colleen Feltmate, M.D., a gynecologic oncology surgeon at BWH.

Robotic-assisted surgery offers many advantages for the surgeon: True three-dimensional (3D) high magnification vision, greatly lowered blood loss, and normal "intuitive” manipulation of surgical instruments. The technology translates a surgeon's hand movements exactly as he/she does them, but also allows the surgeon to scale their hand movements; a large hand movement at the console can be translated into a micro-precise dissection or exposure. The robot can also filter out hand tremors, enhancing precision.

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