Page 31 - World Journal of Laparoscopic Surgery

WJOLS

Comparison between Robotic Radical Hysterectomy with Laparoscopic and Open Abdominal Radical Hysterectomy
Postoperative Complications Kho and Akl et al reported 21 of 519 (4.1%) patients
were identified with vaginal cuiff dehiscence after robotic
Wound infection following laparoscopy is less but not
rare. Many types of post laparoscopic surgery has been cuff closure. Nine among 21 patients the robotic proce-
19
dure was performed for a gynecologic malignancy.
reported including bladder infection, pelvic cellulitis Older literature review by Magrina JF et al showed that
4
and pelvic abces. there was no difference of intraoperative and postopera-
There are evidences of an increased relative risk tive complication among patiens who underwent robotic,
of vaginal cuff complications for minimally invasive laparoscopic and abdominal radical hysterectomy. 20
hysterectomy techniques when compared to vaginal or
abdominal ones. It may be associated with an extensive Hospital Stay and Costs
use of monopolar and bipolar electrosurgery, which may Kruijdenberg et al reported a shorter median hospital stay
increase thermal injury and devascularization of the cuff for the robotic radical hysterectomy than laparoscopic
site. Other organs are also at risk of thermal injury. Ther- radical hysterectomy, 3.3 days and 6.2 days (p < 0.04),
mal injury to bowel may be more difficult to diagnose respectively. 8
intraoperatively. 4 Tinelli et al also reported a shorter median hospital
Kruijdenberg et al from 342 cases of robotic assisted stay for the robotic radical hysterectomy than laparos-
radical hysterectomy and 914 laparoscopic radical hyster- copic radical hysterectomy, 3 and 4 days. The difference
ectomy reported 9.6 and 5.5% postoperative complication is not statistically significant. 9
respectively (p < 0.05). 8 Lowe and Chamberlain et al reported median hospital
Lowe and Chamberlain et al reported an experience stay of 1 day, among 42 cases of roboti-assisted radical
from multi-institutional, 12% postoperative complica- hysterecrtomy. 11
tions, including: one (2.4%) deep venous thrombosis Estape et al reported a 2.6 days hospital stay in robotic
(DVT), 7.2% infection, and 2.4% bladder/urinary tract group and 2.3 and 4.0 days in laparoscopic and abdominal
complication. 11 radical hysterectomy groups, respectively. 13
Estape et al reported that the incidence of postopera- Comparison between robotic, laparoscopic and abdo-
tive complications was less in the robotic cohort (18.8%) minal radical hysterectomy, Magrina et al reported a
as compared to the laparoscopic (23.5%), and laparotomy short hospital stay in robotic group than in laparoscopic
13
cohorts (28.6%), a. and abdominal radical hysterectomy group, 1.7, 2.4 and
Ucella et al reported vaginal dehiscence in 2 of 665 3.6 days, respectively.
20
(0.3%) patients after laparoscopic hysterectomies with Table 3 summarizes the means hospital stay among
transvaginal colporrhaphy. Their literature search identi- patients of robotic, laparoscopic and open radical hysterec-
fied postoperative vaginal separation 91 of 13.030 (0.66%) tomy.
endoscopic hysterectomies. The incidence of vaginal de-
hiscence was lower for transvaginal cuff closure (0.18%) Oncological Outcomes
than for both laparoscopic [0.64%; odds ratio (OR), 0.28; The primary endpoint to be considered when compa-
95% confidence interval (CI), 0.12–0.65] and robotic (1.64%; ring minimally invasive techniques and conventional
OR, 0.11; 95% CI, 0.04–0.26) colporraphy. Laparoscopic cuff laparotomy for gynecological oncology is the equivalence
closure was associated with a lower risk of dehiscence in terms of surgical staging completeness and survival.
than robotic closure (OR, 0.38; 95% CI, 0.28 to 0.6). 17 Oncological outcomes after radical hysterectomy for early
Vaginal cuff separation is a rare but a serious compli- cervical cancer are the number of lymph node retrieved
cation following hysterectomy. Nick et al reported among and the recurrence rate. There are controversial results
36 laparoscopic radical hysterectomy and 19 robotic- concerning the number of lymph nodes collected by diffe-
assisted radical hysterectomy, 7 (1.7%) developed a cuff rent surgical approaches.
complication. Three (1.1%) patients in the laparoscopy
group suffered a vaginal cuff evisceration (n = 2) or sepa- Table 3: Hospital stay (in day) among patient after robotic radical
ration (n = 1). Four patients in the robotic group (3.0%) had hysterectomy (RRH), laparoscopic radical hysterectomy (LRH)
and open radical hysterectomy (ORH)
a vaginal evisceration (n = 1) or separation (n = 3). Vaginal No. Authors RRH LRH ORH p
cuff complication were 9.46 fold higher among patients 1. Kruijdenberg et al 8 3.3 6.2 < 0.04
who had a radical hysterectomy (p < 0.01). Median time 2. Tinelli et al 9 3 4 nS
to presentation of vaginal cuff complication was 128 days 3. lowe et al 11 1
13
(58–175) in the laparoscopy group and 37 days (32–44) in 4. estape et al 2.6 2.3 4.0
the robotic group. 18 5. Magrina et al 20 1.7 2.4 3.6
World Journal of Laparoscopic Surgery, January-April 2015;8(1):26-31 29