Page 29 - World Journal of Laparoscopic Surgery

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Comparison between Robotic Radical Hysterectomy with Laparoscopic and Open Abdominal Radical Hysterectomy
emerged in the context of minimally invasive surgery Salicrú and Gil-Moreno et al found the operative time
to overcome shortcomings of conventional laparoscopy. for laparoscopic radical hysterectomy longer than open
Robotic system provides three-dimensional (3D) view, abdominal radical hysterectomy. 6
more ergonomic surgeon position and articulated wrist- Sert and Abeler describe 35 patients with early
like instruments, increasing surgical precision, and dex- cervical cancer who underwent robot assisted radical
7
terity. Robotic also decrease the fatique that the doctors hyste rectomy, laparoscopic radical hysterectomy and
experience during surgeries that can last several hours. 26 abdo minal radical hysterectomy, showing mean
Exhausted surgeon can experience hand tremors as a operating times 263 minutes for robot-assisted radical
result. The da Vinci has been programmed to compensate hysterectomy, 364 minutes for laparoscopic radical hyste-
for tremors, so if the surgeons hands shakes, the computer rectomy and 163 minutes for open abdominal radical
ignores it and keep the mechanical arm steady. hysterectomy. 7
The robotic application grew rapidly in gynecolo- Kruijdenberg and van den Eiden et al among 342 cases
gical oncology field, especially for technically challenging of robotic assisted radical hystetrectomy and 914 cases of
procedures by laparoscopy, such as radical hysterectomy. total laparoscopic radical hysterectomy, found that there
The use of a robotic system in preset laboratory drills was no statistical difference of mean operative time bet-
has been associated with faster performance times, ween the robotic and laparoscopic radical hysterectomy. 8
increased accuracy, enhanced dexterity, faster suturing, A similar operative time was reported by Tinelli et al
and reduced number of errors when compared to con- 323 minutes for robotic assisted radical hysterectomy
ventional laparoscopic procedure. and 255 minutes for laparoscopic radical hysterectomy
Complex operations, such as radical hysterectomy, can (p < 0.005). 9
be addressed in a more efficient fashion and the skills to Retrospective study by Lee and Kang et al also found
perform this procedure are acquired not only in a shorter no statistically significant difference existed between the
time but by a larger number of laparotomy surgeons who laparoscopic radical hysterectomy and radical abdo minal
encountered difficulties with conventional laparoscopy. 4,5 hysterectomy with respect to operative time. 10

From a multi-institutional experience Lowe and
OBjECTivE
Chamberlain et al found median operative time for
In the present paper, we sought to review the available des- robotic-assisted radical hysterectomy 215 minutes. 11
criptive evidences and to compare intraoperative, patho- From prospective studies of 7 patient who underwent
logic finding, and postoperative, oncological outcomes of robot-assisted radical hysterectomy and 7 patients who
robot-assisted, laparoscopic and open abdominal radical underwent traditional radical hysterectomy, Lowe and
hysterectomy, in the treatment of early cervical cancer. Hoekstra et al found the diference of operative time

statitically not significant, 260 minutes in robot-assisted
MATERiALS And METHOdS
radical hysterectomy and 264 minutes in traditional radi-
We searched the articles about robotic-assisted radical cal hysterectomy. 12
hysterectomy, laparoscopic radical hysterectomy and Estape et al compared 32 patiens who underwent
abdominal radical hysterectomy of early cervical cancer robotic radical hysterectomy with 17 patients laparoscopic
by google search engine and pubMed. We tried to elabo- radical hysterectomy and 14 patients abdominal radical
rate the most recent publications. hysterectomy. Operative time for the robotic group was

2.4 h ± 0.8 and not significantly different from the laparos-
REviEw ARTiCLES
copic group at 2.2 ± 0.7 hours nor the laparotomy group
Mean Operating Time (1.9 ± 0.6 hours p = 0.05). 13
Longer operative time and learning curve are among Nezhat et al in their prospective analyzed cases of
the reasons why the minimally invasive staging has not robotic radical hysterectomy and laparoscopic radical
yet been adopted worldwide in gynecological oncology hysterectomy found no statistical difference were
practice. For robotic system, total operative time consists observed regarding operative time, (323 vs 318 minutes. 14
of docking time and console time. The first is the time Table 1 summarizes the means operating time of
needed to assemble instruments and attach patient to robotic, laparoscopic and open radical hysterectomy.
the robot, advancing the column to the operating table, Blood Loss and Blood Transfusion
fastening the robotic arms to the inserted trocars, and
introducing the laparoscope. Console time is defined as There is general agreement about the significant decrease
the surgical time needed to perform the entire operation of intraoperative bleeding in minimally invasive sur-
5
at the console. gery. This benefit is confirmed also for robotic-assisted
World Journal of Laparoscopic Surgery, January-April 2015;8(1):26-31 27