Robotic surgery in gynecologic oncology: Retrospective and comparative study with laparotomy and laparoscopy

Objectives. - To compare robot-assisted laparoscopy with conventional laparoscopy and laparotomy in gynecologic oncology. Patients and methods. - This is a monocentric retrospective study enrolling 92 patients who underwent a standard or radical hysterectomy (with parametrectomy) with or without pelvic lymphadenectomy between January 2008 and December 2010. All patients were diagnosed for a cervical or endometrial cancer. Laparotomy was performed for 33 patients, conventional laparoscopy for 20 patients, and robot-assisted laparoscopy for 39 patients. The main parameter was the length of hospital stay in the three groups. Results. - Length of hospital stay significantly decreased in the robotic group in comparison with the laparotomic group (median 5 and 8 days respectively, P<0.0001), but no differences were found between the robotic and laparoscopic groups (P=0.77). Intraoperative blood loss was lower in the robotic group. Intraoperative complications and lymph nodes removed were equal in the three groups. Regarding the data recorded, there were no significant differences between conventional and robotic laparoscopy. Hysterectomies performed after pelvic radiation, which were all made by laparotomy before the robot's arrival, were all performed with robotic laparoscopy since its arrival. Conclusion. - Robotic surgery allows a reduced length of hospital stay and a lower blood loss in comparison with laparotomy, without any worse oncologic results. Robotic surgery changed our practice, especially hysterectomy after pelvic radiation, performed by laparotomy before. (C) 2012 Elsevier Masson SAS. All rights reserved.