Page 28 - World Journal of Laparoscopic Surgery

WJOLS

Boy Busmar 10.5005/jp-journals-10033-1241
Literature revieW

Comparison between Robotic Radical Hysterectomy with

Laparoscopic and Open Abdominal Radical Hysterectomy
in the Treatment of Early Stage Cervical Cancer

Boy Busmar

ABSTRACT Africa (ASRs 23.9 and 23.0 per 100,000 respectively).
Robot-assisted procedures are being increasingly incorporated Rates are lowest in Western Asia, Northern America and
in gynecologic oncology. Several studies have confirmed the Australia/New Zealend (ASRs less than 6 per 100,000).
feasibility and safety of robotic radical hysterectomy for selected Cervical cancer remains the most common cancer
patients with early-stage cervical cancer. It has been demons- only in Eastern Africa, South Central Asia and Melanesia.
trated that robotic radical hysterectomy offers an advantage
over laparoscopic and open abdominal radical hysterectomy Overall, the mortality incidence ratio is 52%, and cervical
approaches with regard to operative time, blood loss and cancer is responsible for 2,75,000 deaths in 2008, about
hospital stay. 88% of which occur in developing countries. 1
Also, initial evidences concerning oncological outcomes
seem to confirm the equivalence to traditional open technique. The gold standard for over 100 years for early stage
Despite the fact that costs of robotic system are still high, they cervical cancer was open radical hysterectomy with pelvic
could be compensated by several health-related and social lymph node dissection, resulting in 5-year survival rates
benefits: less pain, faster dismissal, and return to full activity
than other surgical approaches. of 75 to 90%. Intermediate risk factors for recurrence after
radical hysterectomy include tumor size, lymphovascu-
Keywords: abdominal radical hysterectomy, blood loss, con-
version rate, early cervical cancer, hospital stay, laparoscopic lar space invasion (LVSI), and high risk factors include
radical hysterectomy, number of lymph node, operative time, parametrial involvement, lymph node metastasis, and
postoperative infection, Recurrence, Robot-assisted radical resection margin involvement. 2
hysterectomy, urinary tract complication.
In 1984, Kurt Semm was the first to describe laparo s -
How to cite this article: Busmar B. Comparison between copic assistance at the time of vaginal hysterectomy.
Robotic Radical Hysterectomy with Laparoscopic and Open
Abdominal Radical Hysterectomy in the Treatment of Early In 1989 Reich et al, performed the first laparoscopic
Stage cervical cancer. World J Lap Surg 2015;8(1):26-31. hysterectomy. Soon after, enthusiastic pioneers claimed
Source of support: nil laparoscopic hysterectomy to be a better alternative to
abdominal hysterectomy because of its lower postopera-
Conflict of interest: none
tive morbidity, cosmetic result and reduced costs with no
increase in complication rates. Now, it became the new
inTROduCTiOn technique to replace abdominal hysterectomy. 3,4

Cervical cancer is the third most common cancer in In the past two decades, the gynecologic oncologic
women, and the seventh overall, with an estimated surgeons performed minimally invasive techniques in
5,30,000 new cases in 2008. More than 85% of the global order to decrease morbidity while maintaining surgical
burden occurs in developing countries, where it accounts and oncological outcomes.
for 13% of the female cancers. High risk regions are The laparoscopic approach provides comparable
Eastern and Western Africa (Age Standardized incidence long-term outcomes to open radical hysterectomy by
Rate (ASR) greater than 30 per 100,000), South Central adding benefits of minimally invasive surgery in terms
Asia (ASRs 24.6 per 100,000), South America and Middle of blood loss, analgesic requirement and hospital stay.
Despite all these clear advantages, laparoscopic radical
hysterectomy was not widely adopted in surgical prac-
consultant tice, probably due to some drawbacks of this technique:
long learning curve, two-dimensional (2D) view, poor
Department of Obstetrics and Gynecology, Division of
Gynecologic Oncology, Persahabatan Hospital, Rawamangun ergonomics surgeon position, and limited instruments
East Jakarta, Indonesia movements. These conditions negatively influenced the
Corresponding Author: Boy Busmar, Consultant, Department surgical performance, resulting in more tremor, fatigue,
of Obstetrics and Gynecology, Division of Gynecologic and subsequent less accuracy.
Oncology, Persahabatan Hospital, Rawamangun, East Robot-assisted technique through the da Vinci surgi-
Jakarta-13220, Indonesia, e-mail: boybusmar@gmail.com
cal system (Intuitive Surgical Inc, Sunnyvale, Calif, USA)
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