Page 32 - World Journal of Laparoscopic Surgery

Boy Busmar
Recent review of a large series by Kruijdenberg et al Table 4: Number of lymph nodes resected after robotic radical
showed that there is no difference in the number of lymph hysterectomy (RRH),), laparoscopic radical hysterectomy (LRH)
node resected, between robotic-assisted radical hysterec- and open radical hysterectomy (ORH)
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tomy and total laparoscopic hysterectomy. No. Authors RRH LRH ORH p
Regarding recurrent rate comparison between robotic 1. Kruijdenberg et al 8 nS nS nS
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radical hysterectomy and laparoscopic radical hysterec- 2. lee et al 12 19 nS nS
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3. lowe et al
tomy, Tinelli et al found no significant difference. 9 4. estape et al 13 32.4 18.6 25.7 < 0.0001, p
Lee et al in the retrospective study reported that there 0.05
was no significant difference of the number of lymph 5. nezhat et al 14 25 31
nodes resected between laparoscopic and radical abdo- 6. Kho et al 21 15.6 17.1 0.532
mional hysterectomy. 10 7. boggess et al 22 RRh > oRh 0.0003
Lowe and Hoekstra et al reported the similar number one of the most important advantages of minimally inva-
of lymph nodes resected in robotic radical hysterectomy
and abdominal radical hysterectomy, 19 and 14 nodes, sive surgery. All comparative studies concerning robotic
respectively. 12 radical hysterectomy reported a mean length of hospital
stay of 1 to 2 days, similar to the laparoscopic group, but
Estape et al reported the number of lymph nodes
resected by robotic and laparoscopic radical hysterectomy significantly shorter than the open group.
was significantly different, 32.4 and 18.6, p < 0.0001. The Accordingly, robotic surgery provides other advan-
number of lymph nodes resected by laparotomy radical tages, such as lower perioperative complications and
reintervention rates, less postoperative pain, and anal-
hysterectomy was 25.7, p = 0.05. 13
Nehzat et al reported the the number of lymph nodes gesic consumption. All these issues positively influence
resected by robotic radical hysterectomy and laparoscopic hospital stay, quality of life, and time to return to full
activities, providing a benefit from a medical and socio-
radical hysterectomy almost the same, 25 and 31 nodes,
respectively. And no recurrences in laparoscopic and economic point of view.
However, longer operative time and a possible high
robotic radical hysterectomy groups at 12 months and cost due to sophisticated instrument, robotic radical
in laparoscopic group at 29 month. 14
In the prospective study by Magrina et al all patients hysterectomy has advantages over conventional sur-
of the three groups are alive and free from disease at gery, including short hospital stay, lower perioperative
complication, enhanced precision and reduced trauma
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mean follow-up of 31.1 months. to the patient, less bleeding, less postoperative pain and
A comparative study by Kho and Muto et al showed analgesic consumption. All these issues influence quality
a mean number of lymph nodes resected did not differ of life and time to return to full activities, providing a
between robotic radical hysterectomy and open radical benefit from a medical and socioeconomic point of view.
hysterectomy (15.6 vs 17.1, p = 0.532). 21 An increased risk of vaginal cuff complications for
Boggess et al reported number of lymph nodes minimally invasive hysterectomy techniques when
resected during robotic assisted radical hysterectomy compared to vaginal or abdominal ones, may be associ-
and open radical hysterectomy. There is a significant ated with an extensive use of monopolar and bipolar
diffe rences between the number of lymph nodes resected, electrosurgery, which may increase thermal damage
in favor of robotic radical hysterectomy (p = 0.0003). 22 and devascularization of the cuff site. This thermal
Finally, Cantrell et al assessed the progression-free injury is difficult to estimate its extent of damage by
and overall survival for 71 women who attempted RRH visual inspection as the zone of desiccation may exceed
for cervical cancer. Their experience demonstrated that the area of visual damage. An understanding of the dif-
RRH appears to have equivalent oncological outcomes fering impacts of the various types of electrical current
compared with laparotomic surgery in the first 3 years is essential for estimation of the extent of injury. With
of follow-up. They showed a 94% of progre ssion-free and patience, prudence, and meticuluos technique, thermal
overall survival in the robotic cohort at 36 months. 23 injury could be prevented.
Table 4 summarizes the means number of lymph The outcome of the robotic radical hysterectomy
nodes resected among patients of robotic, laparoscopic surgery according to oncological points of view is accept-
and open radical hystetrectomy. able, in term of surgical completeness, number of nodes
resected, recurrence and survival rate.
diSCuSSiOn
The reviewed data suggests that robotic-assisted
Robot-assisted radical hysterectomy is associated with a radical hysterectomy may offer an alternative to tradi-
long operative time. The shorter length of hospital stay is tional radical hysterectomy. The growing literature about
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