Perioperative Outcomes of 3-Arm Versus 4-Arm Robotic Radical Hysterectomy in Patients with Cervical Cancer.

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Perioperative Outcomes of 3-Arm Versus 4-Arm Robotic Radical Hysterectomy in Patients with Cervical Cancer.

J Minim Invasive Gynecol. 2017 Dec 26;:

Authors: Yim GW, Eoh KJ, Chung YS, Kim SW, Kim S, Nam EJ, Lee JY, Kim YT

Abstract
STUDY OBJECTIVE: To investigate and compare surgical outcomes of 3 versus 4 robotic arm approach for robotic surgery in patients with cervical cancer.
DESIGN: Retrospective analysis of prospectively-collected data (Canadian Task Force II-2).
SETTING: Academic tertiary hospital PATIENTS: A total of 142 patients with stage 1A1-IIB cervical carcinoma that underwent robotic surgery were included for analysis. The subjects were divided according to the surgical approach (number of robotic arms) and the two groups were compared in terms of intraoperative data and postoperative outcomes.
INTERVENTIONS: Robotic radical hysterectomy (RRH) with lymphadenectomy using 3 robotic arms (n = 101) versus 4 robotic arms (n = 41).
MAIN OUTCOME MEASURES: Perioperative surgical outcomes RESULTS: Three-arm robotic approach consisted of a camera arm, 2 robotic arms, and 1 conventional assistant port. An additional robotic arm was placed on the right side of the patient's abdomen for the 4-arm robotic approach. Mean age, body mass index, cell type, FIGO (International Federation of Gynecology and Obstetrics) stage, and type of surgery were not significantly different between the two cohorts. Three-arm approach showed favorable outcomes over 4-arm approach in terms of postoperative pain at 6 and 24 hours (3.8 ± 1.8 vs 4.5 ± 1.7 and 2.8 ± 1.7 vs 3.4 ± 1.6, respectively, p = .033 and .049) and postoperative hemoglobin difference (1.8 ± 0.9 vs 2.6 ± 1.3 and 1.9 ± 1.1 vs 2.4 ± 0.9 on day 1 and 3, respectively, p = .002 and .004). The median length of postoperative hospital stay, total operative time, docking time, lymph node yield, intraoperative and postoperative complication rates were comparable between the two cohorts.
CONCLUSIONS: Surgical outcomes and complications rates of RRH for cervical cancer using the 4-arm approach were comparable to that of the 3-arm approach with decreased early postoperative pain in the 3-arm group. Cost-benefit analysis as well as the impact on surgical training is needed in the future.

PMID: 29287717 [PubMed - as supplied by publisher]

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