Outcomes for Robotic Hysterectomy Similar to Laparoscopic Technique

Performing minimally invasive hysterectomy, with or without the assistance of robotic equipment, produced similar, positive outcomes in women with endometrial cancer, according to a new study.

Researchers at the Cleveland Clinic (OH, USA) identified 22 comparative studies published between 2005 and 2010 that described clinical outcomes of robotic-assisted surgeries, compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer. The studies selected for inclusion reported at least 25 robotic cases that also addressed surgical technique, complications, and perioperative outcomes. All patients underwent total hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy.

The researchers found eight eligible comparative studies that included 1,591 patients (589 robotic cases, 396 laparoscopic cases, and 606 laparotomy cases). The pooled mean number of resected aortic lymph nodes for robotic hysterectomy and laparoscopy were 10.3 and 7.8, and those for robotic hysterectomy and laparotomy were 9.4 and 5.7. The pooled means of pelvic lymph nodes for robotic and laparoscopic hysterectomy were 18.5 and 17.8, and 18 compared with 14.5 for robotic hysterectomy compared with laparotomy. Estimated blood loss was reduced in robotic hysterectomy compared with laparotomy and laparoscopy, and length of stay was shorter for both robotic and laparoscopic cases compared with laparotomy, as was operative time. Conversion to laparotomy for laparoscopic hysterectomy was 9.9%, compared with 4.9% for robotic cases. Vascular, bowel, and bladder injuries, cuff dehiscence, and thromboembolic complications were similar for each surgical method. The study was published in the December 2010 issue of Obstetrics & Gynecology.

"Robotics increases the chance that a hysterectomy can be done by laparoscopy,” concluded lead author Giorgia Gaia, MD, and colleagues of the department of obstetrics and gynecology. "However, if the surgeon is skilled enough to do the hysterectomy without the robot by laparoscopy, then the outcomes will be similar.”

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