The comparison of surgical outcomes and learning curves of radical hysterectomy by laparoscopy and robotic system for cervical cancer: an experience of a single surgeon
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Objective The aim of this study was to compare and determine the feasibility, surgical outcomes, learning curves of roboticradical hysterectomy with lymph node dissection (RRHND) to conventional laparoscopic radical hysterectomy withlymph node dissection (LRHND) performed by a single surgeon, in patients with cervical cancer. Methods Between April 2009 and March 2013, 22 patients underwent LRHND and 19 patients underwent RRHND. Variablessuch as age, body mass index, International Federation of Gynecology and Obstetrics stage, histological Results ,number of dissected lymph nodes, operative time, estimated blood loss, days of hospitalization and complicationswere reviewed. Learning curves of operation time was obtained using cumulative sum (CUSUM) method. Results Both groups showed similar patient and tumor characteristics. In surgical outcome analysis, RRHND (51.8±10.4minutes) showed longer preparing time than LRHND (42.5±14.1 minutes). In the LRHND group, 8 patients experiencedpostoperative complications (5 void difficulty, 1 postoperative bleeding, 1 right basal ganglia infarction, 1 fever). Onthe other hand, in the RRHND group, 4 patients experienced a postoperative complication (2 bleeding, 1 peritonitis,1 dehiscence of trocar site). Using CUSUM method, the learning curves were obtained by plotting the cumulativesequential differences between each data point and the average operation time, and showed two distinct phases inboth type of operations. Conclusion RRHND would be appropriate surgical approach in patients with cervical cancer with favorable outcome ofless voiding difficulty. A minimum of 13 cases of robotic radical hysterectomies are required to achieve surgicalimprovement in the treatment of cervical cancer.
Abstract
Objective The aim of this study was to compare and determine the feasibility, surgical outcomes, learning curves of roboticradical hysterectomy with lymph node dissection (RRHND) to conventional laparoscopic radical hysterectomy withlymph node dissection (LRHND) performed by a single surgeon, in patients with cervical cancer. Methods Between April 2009 and March 2013, 22 patients underwent LRHND and 19 patients underwent RRHND. Variablessuch as age, body mass index, International Federation of Gynecology and Obstetrics stage, histological Results ,number of dissected lymph nodes, operative time, estimated blood loss, days of hospitalization and complicationswere reviewed. Learning curves of operation time was obtained using cumulative sum (CUSUM) method. Results Both groups showed similar patient and tumor characteristics. In surgical outcome analysis, RRHND (51.8±10.4minutes) showed longer preparing time than LRHND (42.5±14.1 minutes). In the LRHND group, 8 patients experiencedpostoperative complications (5 void difficulty, 1 postoperative bleeding, 1 right basal ganglia infarction, 1 fever). Onthe other hand, in the RRHND group, 4 patients experienced a postoperative complication (2 bleeding, 1 peritonitis,1 dehiscence of trocar site). Using CUSUM method, the learning curves were obtained by plotting the cumulativesequential differences between each data point and the average operation time, and showed two distinct phases inboth type of operations. Conclusion RRHND would be appropriate surgical approach in patients with cervical cancer with favorable outcome ofless voiding difficulty. A minimum of 13 cases of robotic radical hysterectomies are required to achieve surgicalimprovement in the treatment of cervical cancer.
참고문헌 (20)
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