Each year, more than 40,000 women are diagnosed with endometrial cancer in the United States. This diagnosis, often resulting in the need for a hysterectomy, leads many patients to consider their treatment options. Traditionally, the surgical options have been somewhat limited for these women, including open hysterectomy and laparoscopy. Open hysterectomy has been associated with important caveats for patients to consider, including scarring, excessive procedural blood loss, and extended hospital stays with long recovery times. Minimally invasive laparoscopy significantly reduces some of the risks associated with open hysterectomy. Robotic surgery equipment has also emerged after receiving FDA clearance in 2005, and these procedures are increasingly being used for patients with endometrial cancer.
Treatment Options for Endometrial Cancer
In the December 2010 issue of Obstetrics & Gynecology, my colleagues and I reviewed eight studies involving nearly 1,600 women who underwent open surgery, laparoscopy, robot-assisted hysterectomy, or lymph node dissection. We compared them with laparoscopic or laparotomy cases to analyze surgical technique, complications, and perioperative outcomes. Comparative studies that looked at clinical outcomes of robotic-assisted surgeries were also summarized and compared with traditional laparoscopic or laparotomy techniques for the treatment of endometrial cancer.
“Robotic-assisted surgery has the potential for enhancing outcomes in women receiving operative treatment for endometrial cancer.”
According to our analysis, women undergoing surgery for endometrial cancer can benefit from minimally invasive hysterectomy that is performed by skilled surgeons with or without the help of robotic technology. Laparoscopic surgery with or without robotic assistance took about the same time to complete and resulted in similar hospital stay durations. It should be noted, however, that about half as much blood was lost in robotic-assisted cases. Both of these minimally invasive techniques resulted in longer operative times than open surgery, but both also led to shorter hospital stays. The average number of lymph nodes resected was similar in robotic and open procedures. We observed no significant differences between methods in the number of complications, but there was a trend for fewer laparotomy conversions with robotics when compared with laparoscopy (P=0.06).
Robotic Surgery Benefits Endometrial Cancer
Robotic-assisted surgery is essentially computer-assisted laparoscopic surgery. The robotic instruments and cameras are integrated into robotic arms and are electronically controlled from a surgeon console. While seated, the surgeon looks into a high-definition 3-dimensional vision system and uses hand/foot controls to manipulate the robotic instruments. The robotic equipment provides better vision, wristed instrumentation with improved range of motion, and improved surgeon ergonomics, compared to traditional laparoscopy. These specific features enhance surgeons’ abilities to perform complex surgeries, and likely accounts for the rapid adoption of robotic-assisted surgery by gynecologic oncologists. For patients, the benefits of robotic-assisted surgery include significantly less pain, less blood loss, shorter hospitalization, quicker recovery, and fewer complications when compared with open surgery.
Robotics make it easier for surgeons to transition from open to minimally invasive procedures and can increase the chance that a hysterectomy be done laparoscopically. It should be noted, however, that surgeons should have at least the basic knowledge of traditional laparoscopy; all robotic procedures require establishing pneumoperitoneum and placement of operative ports, similar to laparoscopy. The good news is that the available data support the notion that, as more women are offered a minimally invasive option, robotic-assisted surgery has the potential for enhancing outcomes in women receiving operative treatment for endometrial cancer. As research further supports our findings, the hope is that outcomes will continue to improve, regardless of the selected procedure.
Readings & Resources (click to view)
Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol. 2010;116:1422-1431. Available at:http://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2010&issue=12000&article=00029&type=abstract
Holloway RW, Ahmad S, DeNardis SA, et al. Robotic-assisted laparoscopic hysterectomy with lymphadenectomy for endometrial cancer: analysis of surgical performance. Gynecol. Oncol. 2009;115:447-452.
Holloway RW, Patel SD, Ahmad S. Robotic surgery in gynecology. Scand J Surg. 2009;98:96-109. Available at: http://www.fimnet.fi/sjs/articles/SJS22009-96.pdf.
Mendivil A, Holloway RW, Boggess JF. Emergence of robotic assisted surgery in gynecologic oncology.Gynecol Oncol. 2009;114(Suppl):S24-S31.