Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study

Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study Noor Azura Noor Mohamad, Jung Chul Kim, Sang Wun Kim This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2826688/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Da Vinci SP robotic platform is utilized in benign gynecology, with no study of its use for cervical cancer surgery till date. The study aimed to present clinical experience and surgical outcome of da Vinci SP robotic surgery for cervical cancer stage IA-IB. This cross-sectional study involved patients undergoing da Vinci SP robotic type B radical hysterectomy (RH), type C1 RH, and radical trachelectomy (RT) from January 2019 until December 2021. Median age and body mass index were 38 years old (28–49) and 21.6 kg/m 2 (17.6–33.6) respectively. 61.5% were stage IA1, 23.1% IB1 and 15.4% IB2. 6 underwent type B RH, 1 type C RH, and 6 RT. Median docking time, console time and total operation time were 4 minutes (2–9), 151 minutes (75–258) and 278 minutes (159–360) respectively. Median estimated blood loss was 50 mL (10–100). Median pain score was 3, 0, 0, and 0 at 0-, 6-, 12-, and 24-hour post-surgery. Median postoperative hospital stay was 2 days (2–4). In conclusion, da Vinci SP robotic surgery for cervical cancer stage IA-IB could be performed with good peri-operative surgical outcomes. Large scaled long-term follow-up studies are required to assess oncological outcomes of patients undergoing these procedures. Health sciences/Oncology/Surgical oncology Biological sciences/Cancer/Gynaecological cancer Figures Figure 1 Figure 2 Figure 3 Introduction Minimally invasive surgery (MIS) for early-stage cervical cancer undergoes progressive development and acceptance since assimilation of robotic technology into gynecologic cancer surgery in 2005. Patients undergoing robotic surgery have lesser operative complications, reduced estimated blood loss (EBL) and shorter postoperative hospital stay (POHS) [ 1 – 4 ]. From 3-robotic arm [ 2 , 5 ] to adding the 4th robotic arm [ 6 ], attempts have been made to refine the practicality of robotic platform in surgery for cervical cancer. Single-port robot-assisted surgery using da Vinci Si has been looked at and was limited by crowding and collision of the robotic arms, large umbilical incision of 30–40 mm, and inadequate traction with 5 mm robotic instruments [ 7 ]. The uptake of MIS among gynecologic oncologist plummets since 2018 Laparoscopic Approach to Cervical Cancer (LACC) trial revealed inferior 4.5-year overall survival for patients undergoing minimally invasive radical hysterectomy [ 8 , 9 ]. Robotic surgery comprised 16% of the trial participants hence it was difficult to extrapolate the trial result for this group [ 1 ]. Within the same year LACC trial release, robotic technology welcomed its new addition of da Vinci SP. The robotic system is uniquely designed for surgery via a single trocar that permits simultaneous utilization of 3 instruments and an endoscope [ 10 ]. Its dual-jointed robotic instruments enable freedom of movements within more confined space, and works hand in hand with the all-improved endoscopic camera [ 10 , 11 ]. Da Vinci SP technology is widely incorporated in urology [ 10 ] and benign gynecology [ 11 , 12 ], with no study of its application in gynecologic oncology specifically for cervical cancer till date. The study aimed to present the first clinical experience and surgical outcome of robotic surgery with da Vinci SP for cervical cancer stage IA-IB. Methods Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) 2021 checklist was referred to as a guideline for reporting [ 13 ]. The research was performed in accordance with the Declaration of Helsinki. Informed consent was acquired from each patient to undergo the surgical procedure. However, the consent for use of the patient medical information was not required due to retrospective nature of the study. This single-center cross-sectional study acquired prior Institutional Review Board approval (4-2022-1034). The recruitment occurred at Yonsei Cancer Center, a private academic tertiary referral center, involving patients undergoing robotic surgery for cervical cancer from January 2019 until December 2021. The follow-up duration was from day of operation until November 2022. Electronic health record was examined for (1) clinical characteristics such as age, parity, body mass index (BMI), histologic type, tumor size, lymphovascular space invasion, clinical stage, type of operation and harvested lymph node, (2) intra-operative surgical outcome including docking time, console time, total operation time, intra-operative complication, insertion of ancillary port, conversion to laparotomy, EBL, and uterine weight, and (3) post-operative surgical outcome such as pain score, post-operative analgesia use, urinary catheter at discharge, POHS, and post-operative complication. Inclusion criteria were patients age ≥ 18 years with histologically proven cervical cancer stage IA-IB, and underwent da Vinci SP robotic surgery as primary surgical treatment for cervical cancer. The exclusion criteria were patients undergoing da Vinci SP robotic surgery for cervical cancer after receiving neoadjuvant chemotherapy or chemoradiotherapy, patients that underwent robotic surgery with other robotic platform, and patients that did not attend post-operative follow-up in the institution. Registration number were traced from the registry of robotic operating room which was the operating room exclusive for da Vinci SP platform. Consecutive patients that underwent da Vinci SP robotic type B radical hysterectomy (RH), type C1 RH, and radical trachelectomy (RT) were included. Clinical examination and radiological imaging including computed tomography (CT) of thorax, abdomen and pelvis, magnetic resonance imaging of pelvis, and positron emission tomography (PET)/CT head to mid-thigh were performed to exclude locally advanced disease and metastases. Cervical cancer stage followed the 2018 International Federation of Obstetrics and Gynecology (FIGO) staging. Docking time was calculated from mobilization of da Vinci SP patient cart, to complete insertion of robotic instruments and endoscope into peritoneal cavity. Console time was taken from the start of robotic procedure until undocking. Pelvic and/or para-aortic sentinel lymph node sampling (SLNS) was performed using fluorescence dye indocyanine green (ICG), according National Comprehensive Cancer Network algorithm [ 14 ]. Hysterectomy and trachelectomy were classified according to surgical manual of Korean Gynecologic Oncology Group [ 15 ]. Total operation time included the start of skin incision until completion of wound closure. Pain score was assessed according to Wong Baker Faces Pain Rating Scale at 0-hour, followed by Numerical Pain Intensity Scale at 6-, 12- and 24-hour post-operation. POHS was calculated from the day of operation until discharge. Surgical complication was defined according to Clavien-Dindo system [ 16 ]; these data were captured by reviewing the patients’ medical record from day of operation until October 2022. Recurrence was defined as detection of new tumor growth at interval PET/CT. The confounding variable would be the surgical skill of the surgeon, which was minimized as there was only one surgeon that performed all the procedures. The effect modifier would be the histologic type of cervical cancer, which was minimized as the study only included the common histological types of cervical cancer which would respond to the treatment offered in similar fashion. Clinical characteristics of the patients were available from electronic health record at admission, and histological report of cervical biopsy as well as resected specimen. Intra-operative details of timing for docking, console time, and total operation time were searched from database of the robotic operating room, and post-operative outcome and follow-up data were available from electronic health record. BMI was measured using kilogram and meter, histologic type was reported according to World Health Organization standard of reporting and following FIGO staging. Timing for docking, console time and total operation time were recorded in 24-hour system and the duration for each variable were established by taking the time difference in minutes. Post-operative analgesia requirement was recorded as total dose used in milligram (mg). Potential bias in the study was the limited clinical documentation of the clinical events which may not capture the actual events. This bias was reduced by examining documentation entries by various health practitioners such as doctors, nurses, and allied health professionals in order to capture the necessary data variables. The study size was arrived at by successive recruitment of the patients that met the inclusion and exclusion criteria during the recruitment period. The small number may be explained by the fact that only self-paying patients could undergo the robotic procedure as it was not covered by health insurance. Quantitative variables were handled by taking the median value of the data due to small numbers of participants. Anonymized data tabulated into Microsoft Excel spreadsheet were analyzed using simple statistics to look for mean, median, range and percentage. There was no advanced statistical method used to control confounding factor, or interaction between subgroups. There was no missing data as all the information required were available in the electronic health record. There was no analytical method utilized for sampling strategy. No statistical expertise was employed, nor was there sensitivity analysis for this study. Preparation before robotic procedure: All patients received glycerin and saline enema on the day before surgery. Once under general anesthesia, patient was put at lithotomy position, connected to lower limb pneumatic compression device, hand tucked to patient’s side, and shoulder strained with gel pad over clavicles. Abdominal skin and vagina were sterilized with povidone-iodine Betadine (Woodstock Sterile Solutions, Inc, Illinois, USA) 7.5% solution followed by sterile draping and bladder catheterization. After drying the umbilicus, the skin was marked with 2 dots of 23 mm distance followed by vertical incision in layers. Upon entering the peritoneum, UniPort (Dalim, Seoul, Korea) wound retractor was applied and sealed with its port cover, pneumoperitoneum developed with carbon dioxide up to 12 mm Hg, and SP robotic cannula was inserted into the UniPort channel (Fig. 1 ). The patient was moved to deep Trendelenburg position and da Vinci SP 0-degree camera (Intuitive Surgical, Sunnyvale, USA) was introduced into the peritoneal cavity. The fully-draped patient cart was advanced towards the right side of the patient and docking commenced (Fig. 2 ). The robotic arm was tilted to visualize the pelvic cavity followed by insertion of fenestrated bipolar forceps on arm 1, Cardiere forceps on arm 2, and monopolar curved scissors/cautery hook/needle driver on arm 3. Da Vinci SP robotic procedure: SLNS and RH (Fig. 3 A-L). Fimbrial end of bilateral fallopian tubes were cauterized with bipolar forceps. ICG (Pulsion Medical System, Feldkirchen, Germany) of 2.5 mg/mL was injected at 3 and 9 o’clock, 3–4 mm lateral to cervical os. The ICG volume injected were 1 mL at 3 mm depth, followed by another 1 mL at 20 mm depth. RUMI II with Koh-Efficient Technology uterine manipulator (Cooper Surgical, Connecticut, USA) were used in some patients. Pelvic side wall peritoneum was dissected open to develop pararectal and paravesical space. The lymphatic channels from the cervix were followed through with robotic endoscope fluorescence imaging to identify the sentinel lymph nodes. SLNS was performed, and specimen was sent for histopathological analysis. Uterine artery was coagulated, dissected at its origin, and off the underlying ureter. Uterine vein was identified and ligated with Hem-o-lok clips before cutting. Paracervix was dissected medical (type B RH) or lateral (type C RH) to the ureter, followed by opening of vesicovaginal space caudally until 10–20 mm of vaginal length was exposed. Ureteric unroofing was done to roll ureter off its vaginal attachment. Pouch of Douglas peritoneum was dissected 20 mm caudal to the arch of uterosacral ligament. Bilateral salpingectomy was done, and ovarian ligament was dissected. Colpotomy was performed to include 10–20 mm of vaginal cuff. Specimen was retrieved in specimen bag per vaginally. Vagina and pelvis were irrigated with warm saline followed by vaginal cuff continuous suturing with bidirectional barbed monofilament 1/0 suture Quill (Corza Medical, Massachusetts, USA). Da Vinci SP robotic procedure: SLNS and RT . Except for coagulation of fimbrial end of bilateral fallopian tubes, similar steps of SLNS with RH were performed until opening of Pouch of Douglas peritoneum. Colpotomy was performed to include 10–20 mm of vaginal cuff then uterine isthmus was transected to detach cervix, paracervix and vaginal cuff. The specimen was removed vaginally in a specimen bag. Vaginal cuff was sutured to the uterine isthmus by continuous suturing with 1/0 Quill following the pelvic and vaginal irrigation. Hemostasis and wound closure : Robotic arm was undocked. Robotic endoscope was reintroduced into the peritoneal cavity and irrigation was done with warm saline. Fibrin sealant Tisseel (Baxter Healthcare Corp, Illinois, USA) was applied to pelvic raw surface for hemostasis and Guardix (Dongsung, Korea) for adhesion prophylaxis. Omentum was drawn over the bowel then pneumoperitoneum released. Rectus sheath incision was closed with interrupted suture using 1/0 Vicryl on J needle (Ethicon, USA). 10 mL of 5 mg/mL bupivacaine injection was injected subcutaneously. Umbilical skin was approximated with subdermal interrupted suture with 1/0 Vicryl on J needle (Ethicon, USA). The skin was cleaned and covered with lidocaine-embedded mesh Ridoar Gauze (Sung Kwang Pharm Co Limited, Gyeonggi-do, Korea), then sealed with waterproof bandage. Post-operative care: Only certain patients received patient-controlled analgesia (PCA). Regular oral analgesia (non-steroidal anti-inflammatory drugs and gabapentin) was served every 6–8 hours in the ward. Regular interval pain score was recorded as per nursing shift. Indwelling urinary catheter removal and discharge day was decided at daily ward review by the surgeon. Oral antibiotic and oral analgesia were provided at discharge. Patient returned to outpatient clinic in 1–2 weeks to review histopathology results. Results There were 14 patients eligible for recruitment during the study period. One patient was excluded for having surgery after receiving primary chemoradiotherapy. Total 13 patients were included in the study, completed follow-up at the institution, and analyzed. Table 1 summarized the characteristics of patients undergoing da Vinci SP robotic surgery in cervical cancer (n = 13). Median age and median body mass index were 38 years old (range, 28–49) and 21.6 kg/m 2 (range, 17.6–33.6) respectively. Seven (54%) patients were nulliparous, 6 (46%) patients had previous abdominopelvic surgery, none of the patient smoke, and 7 (61.5%) patients had human papillomavirus infection. Seven (54%) patients had squamous cell carcinoma of cervix, 5 (39%) patients had adenocarcinoma and 1 (8%) patient had mixed histology of neuroendocrine and adenocarcinoma. FIGO stage IA1 was 61.5%, IB1 was 23.1%, and IB2 was 15.4%. Seven (54%) patients underwent RH and 6 (46%) patients underwent RT. All patients underwent SLNS, including one systematic lymphadenectomy. All nulliparous patients underwent fertility-preserving surgery (RT) except for one patient who had suspected synchronous tumor of endometrium and cervix. Median harvested LNs was 9 (range, 0–47). Table 1 Patient characteristics of da Vinci SP robotic surgery in cervical cancer (n = 13) Case Age Parity BMI Histology T diameter (mm) T depth (mm) LVSI FIGO stage Surgery Harvested LN 1 31 0 20 SCC 25 6 No 1B2 RT 12 2 32 1 33.6 SCC 2 1 No 1A1 B RH 0 3 32 0 21.9 AC 11 > 2 No 1B1 RT 9 4 42 1 28.2 SCC < 1 < 1 No 1A1 B RH 6 5 49 2 21.3 AC 13 5 No 1B1 B RH 47 6 28 0 21.2 AC 12 0.7 No 1A1 RT 14 7 44 1 17.6 AC 6 1 No 1A1 B RH 9 8 46 2 21.9 SCC 6 0.5 No 1A1 B RH 3 9 30 0 20.2 NE + AC 3 2 Yes 1A1 RT 10 10 41 0 23.1 SCC 18 7 No 1B1 RT 16 11 32 0 19.2 SCC 14 2 No 1A1 RT 3 12 49 2 25.7 SCC > 20 > 5 Yes 1B2 C1 RH 10 13 38 0 21.6 AC < 1 < 1 No 1A1 B RH 6 AC: adenocarcinoma; BMI: body mass index; C1: type C1 hysterectomy; FIGO: International Federation of Obstetrics and Gynecology; LN: lymph node; LVSI: lymphovascular space invasion; NE: neuroendocrine; RH: radical hysterectomy; RT: radical trachelectomy; SCC: squamous cell carcinoma; T: tumor; B: type B hysterectomy Table 2 showed the surgical outcomes of patients undergoing da Vinci SP robotic surgery in cervical cancer. Median docking time, median console time and median total operation time were 4 minutes (range, 2–9), 151 minutes (range, 75–258) and 278 minutes (range, 159–360) respectively. Median EBL and median uterine weight were 50 mL (range, 10–100) and 148 g (range, 109–185) respectively. There was no ureteric or bowel or vascular injury. No patient required ancillary port or conversion to laparotomy. Table 3 showed the post-operative outcomes of da Vinci SP robotic surgery in cervical cancer. Median value for pain score was 3, 0, 0, and 0 at 0-, 6-, 12-, and 24-hour post-surgery. There were 2 (15.4%) patients who received PCA. Median Tramadol and Pethidine dosage were 50 mg (range, 0-150) and 0 mg (range, 0–50) respectively. There was 1 (7.6%) patient (case 5) that was discharged home with indwelling urinary catheter which was removed at 2 weeks post-type B RH. Median POHS was 2 days (range, 2–4). Case 1 (5 days post-RT) had cystitis treated with oral antibiotics. There was no post-operative ileus, umbilical hernia or infection, vaginal cuff dehiscence, and no lymphedema. All surgical margins and sentinel lymph nodes were negative for malignancy. There was one recurrence (case 3, RT for FIGO stage IB1, adenocarcinoma) on the paraaortic and left common iliac lymph nodes diagnosed at 16-month disease-free interval. Table 2 Surgical outcomes of da Vinci SP robotic surgery in cervical cancer (n = 13) Case Docking T (min) Console T (min) Intraop compl Total op T (min) Convert to laparotomy Ancil port EBL (mL) Uterine weight (g) 1 9 198 No 360 No No 30 NA 2 2 130 No 207 No No 20 109 3 2 155 No 277 No No 30 NA 4 4 88 No 159 No No 50 148 5 3 186 No 337 No No 50 118 6 5 225 No 358 No No 100 NA 7 6 151 No 319 No No 30 185 8 3 75 No 161 No No 10 172 9 3 258 No 352 No No 100 NA 10 5 135 No 299 No No 100 NA 11 5 176 No 278 No No 50 NA 12 3 126 No 219 No No 50 170 13 6 125 No 252 No No 50 132 Ancil: ancillary; compl: complication; EBL: estimated blood loss; intra−op: intraoperative; NA: not applicable; op: operation; T: time Table 3 Post-operative surgical outcomes of da Vinci SP robotic surgery in cervical cancer (n = 13) Case PS 0 PS 6 PS 12 PS 24 PCA Tramadol (mg) Pethidine (mg) IDC at discharge POHS (day) Postop complication 1 3 0 0 2 Yes 100 0 No 3 UTI 2 3 0 0 0 No 50 0 No 2 No 3 3 3 0 0 No 100 25 No 3 No 4 3 0 1 0 Yes 0 0 No 2 No 5 3 0 0 0 No 0 0 Yes 4 No 6 3 0 0 0 No 50 0 No 2 No 7 3 0 2 0 No 50 0 No 3 No 8 3 0 6 0 No 100 50 No 2 No 9 3 0 0 0 No 0 0 No 3 No 10 3 5 0 3 No 150 25 No 2 No 11 3 0 0 0 No 150 25 No 3 No 12 3 0 0 0 No 100 0 No 3 No 13 3 0 0 0 No 50 0 No 2 No IDC: indwelling urinary catheter; mg: milligram; NA: not applicable; PCA: patient−controlled analgesia; POHS: postoperative hospital stay; postop: post−operative; PS: pain score Discussion The feasibility of performing da Vinci SP robotic surgery lies on successful completion of the procedure via single umbilical incision. A local retrospective study of 59 patients undergoing SPL RH via 15–20 mm single umbilical incision showed that all procedures were successfully completed without converting to laparotomy [ 17 ]. Similar surgical techniques were extended to the current study with 23–25 mm umbilical incision, and all current study procedures were done without conversion to laparotomy. It goes to prove that da Vinci SP robotic platform is versatile, as it allows the surgeon to assimilate their well-established surgical method and achieve similar results with the robotic system. The advantage of da Vinci SP robotic arm is the full swivel trocar that gives surgeon the full liberty of instrument control. The robotic arm is also rotatable towards any direction within peritoneal cavity, hence no limitation to reach any surgical site. Jang et al reported lesser lymph node retrieval with single-site robotic RH which was attributed to limited accessibility to retroperitoneal space with the robotic platform [ 18 ]. In our study, 3 patients successfully had sentinel pelvic and para-aortic lymph node sampling with no intra-operative complication, nor ancillary port insertion. The absence of other intraoperative complication was consistent with previous studies [ 8 , 17 , 19 ]. Shorter console time is desirable in robotic surgery to reduce the duration at deep Trendelenburg position which causes 10–30% reduced cardiac output, and increases the risk of post-operative cognitive disorders [ 20 ]. Median console time in our study was 126 minutes, compared to 102.5 minutes and 117.5 minutes for single-site robotic RH and multiple-port robotic RH respectively [ 18 ]. The slightly longer console time may be ascribed to the surgeon acclimatizing with smaller working space and visual field [ 21 ]. Talamini et al reported that surgeon needed to perform at least 20 consecutive cases of radical prostatectomy to overcome the learning curve when adapting to da Vinci SP technology [ 22 ]. Studies also found that institutional learning curve notably affected the survival outcome of robotic surgery for cervical cancer [ 1 , 23 , 24 ], and the effect was especially more pronounced for tumor ≥ 20 mm [ 24 ]. Peritoneal entry via single umbilical incision with da Vinci SP averts the risk of damaging major anatomic structures. In retrospective by Yim et al, they found that adding the 4th robotic arm resulted in lower post-operative hemoglobin level due to wound hematoma from multiple abdominal incisions [ 6 ]. Median EBL of 50 mL in our study reinstates the reputable reduced EBL in robotic RH. When compared to other surgical modalities, EBL in open RH was 462.27 mL [ 8 ], 145 mL in multiple-port laparoscopic RH [ 2 ], 100 mL in SPL RH [ 17 ], 120 mL in 4-arm robotic RH [ 6 ], 100 mL in 3-arm robotic RH [ 6 ], and 215 mL in single-site robotic RH [ 18 ]. The patients were discharged after 2 days POHS with no re-admission for poorly controlled pain or other post-operative complication, which indicated that the patients tolerated the surgery very well. In cancer patient, surgical scar translates into the experience and memory of cancer diagnosis [ 18 ]. Leaving a small surgical scar not only result in better cosmesis, but also positively impacts in patient’s body image perception [ 25 ]. Umbilical incision hernia is a highlighted complication related to robotic surgery. Obesity [ 26 ], robotic surgery via single incision [ 27 ], peritoneal entry through umbilical incision [ 28 ], and continuous suturing of umbilical incision [ 29 ] increased the risk of umbilical incision hernia in robotic surgery, while interrupted suture technique for umbilical incision reduced the risk of it [ 29 ]. The absence of umbilical incision hernia in our study is compatible with 0.5% incidence of umbilical incision hernia in laparo-endoscopic single site surgery performed via 15–20 mm incision [ 26 ]. Limitations The study involved small number of patients which may not capture the necessary learning curve of performing the procedure with the novel technology. All except 1 patient had BMI less than 30, hence the result cannot be inferred to obese patients with more challenging anatomic visualization, tendency to bleed from the abundance of intraperitoneal fatty tissue, and higher risk of incisional hernia. The follow-up of 9–36 months post-surgery may not capture delayed complication or recurrence. We selected patients with tumor < 40 mm, hence the result may not be applicable to patients with bigger tumor size. In conclusion, da Vinci SP robotic RH or RT could be performed for cervical cancer stage IA-IB with good peri-operative surgical outcomes. However, larger scale randomized-controlled studies are required to assess the long the survival outcomes and benefits of performing surgery with da Vinci SP robot compared to da Vinci Xi system in cervical cancer. Declarations Author contributions statement NANM and SWK contributed to the concept or design of the work. NANM and JCK contributed to the acquisition, analysis, or interpretation of data. NANM and SWK contributed to drafting or critically revising the work. NANM, JCK and SWK provided final approval of the work. All authors have agreed to be accountable for all aspects of the work. 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Laparo-Endoscopic Single Site (LESS) cosmesis: Patients perception of body image distortion after LESS surgery. Am J Surg 221 , 187-194 https://doi.org:10.1016/j.amjsurg.2020.06.002 (2021). Gunderson, C. C. et al. The risk of umbilical hernia and other complications with laparoendoscopic single-site surgery. J Minim Invasive Gynecol 19 , 40-45 https://doi.org:10.1016/j.jmig.2011.09.002 (2012). Wang, W., Sun, X. & Wei, F. Laparoscopic surgery and robotic surgery for single-incision cholecystectomy: an updated systematic review. Updates Surg 73 , 2039-2046 https://doi.org:10.1007/s13304-021-01056-w (2021). Antoniou, S. A. et al. Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20 , 1-10 https://doi.org:10.1007/s10029-015-1371-8 (2016). Noh, J. J., Kim, T. H., Kim, C. J. & Kim, T. J. Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period. Sci Rep 10 , 17388 https://doi.org:10.1038/s41598-020-74471-5 (2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2826688","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":198742607,"identity":"82984084-827d-4b9b-87d5-953c499d1413","order_by":0,"name":"Noor Azura Noor Mohamad","email":"","orcid":"","institution":"Universiti Teknologi MARA","correspondingAuthor":false,"prefix":"","firstName":"Noor","middleName":"Azura Noor","lastName":"Mohamad","suffix":""},{"id":198742608,"identity":"a061f965-622a-4170-8564-6fd73218b023","order_by":1,"name":"Jung Chul Kim","email":"","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Jung","middleName":"Chul","lastName":"Kim","suffix":""},{"id":198742610,"identity":"efccbd25-58f8-46d1-9073-0bbcd97deda4","order_by":2,"name":"Sang Wun Kim","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAoklEQVRIiWNgGAWjYJCCAx8YGBJI0sF4cAapWpgP85CkRb797IHDtm2H8+QbmB9+IEqLwZm8hMO5bYeLDQ6wGUsQp4UhxwCkJXEDA4MZkQ7rf2Nw2BKoZX4D+zfitDDcANrCCNTScICHSFsMbrwxONhzLj1xw2GeYuL8It+fY/zhR5l14vz29o3EhRgYMLIBCWbi1YPAH9KUj4JRMApGwQgDAJOiMnltTUR6AAAAAElFTkSuQmCC","orcid":"","institution":"Yonsei University College of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Sang","middleName":"Wun","lastName":"Kim","suffix":""}],"badges":[],"createdAt":"2023-04-17 10:29:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2826688/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2826688/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":36956852,"identity":"a22ad2d8-c0bb-4b2b-840f-2ad6ebb17f23","added_by":"auto","created_at":"2023-05-12 14:43:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":441140,"visible":true,"origin":"","legend":"\u003cp\u003eDa Vinci SP single docking connection.\u003c/p\u003e\n\u003cp\u003e(A) is the UniPort (Dalim) port cover. Da Vinci SP cannula (B) is inserted into one of the multi-port accesses of 28 mm diameter. The cannula can self-rotate for the purpose of camera positioning either at 12 or 6 o’clock, depending on the surgeon preference. The ability of cannula to be rotated independently of the docking hinge (red arrow) allows for freedom of camera rotation without the need to undock and re-dock. (C) is the robotic arm docked to the da Vinci SP cannula by hinge labelled as the red arrow. Pneumoperitoneum is maintained at 12 mm Hg by integrated insufflation connection (D) at UniPort port cover that is located away from any of the port access hence not risked being pinched by any of the robotic instruments.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-2826688/v1/c43ccb7d2d4c2017de76f77a.png"},{"id":36956850,"identity":"351bba0d-e171-4ca9-97c2-0b46047c3866","added_by":"auto","created_at":"2023-05-12 14:43:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":222699,"visible":true,"origin":"","legend":"\u003cp\u003eThe position of assistant and scrub nurse.\u003c/p\u003e\n\u003cp\u003eThe robotic cart is parked at the right side of the patient. The assistant has access to the smaller multi-port channels of UniPort port cover to assist in suction and irrigation, and passing, taking as well as cutting the suture.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-2826688/v1/9330ef7a0bf720e6f1d75551.png"},{"id":36956851,"identity":"a8925a74-749e-42b5-9d54-396a58d96df4","added_by":"auto","created_at":"2023-05-12 14:43:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2786847,"visible":true,"origin":"","legend":"\u003cp\u003eOperation field views of da Vinci SP robot radical hysterectomy and sentinel lymph node sampling.\u003c/p\u003e\n\u003cp\u003eA: Opening of pararectal and paravesical space. B: Sentinel lymph node biopsy. C: Uterine artery dissection at its origin. D: Uterine vein dissection. E: Dissection of parametrium. F: Opening of vesicouterine space. G: Ureteric unroofing. H: Ureteric tunneling. I: Opening of sacrouterine space. J: Colpotomy. K: Retrieval of specimen vaginally. L: Vaginal cuff closure.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-2826688/v1/13b28d2fd964ee19ccc07a76.png"},{"id":44962120,"identity":"0530eff4-0a6c-4f7b-b614-156aa9c41b52","added_by":"auto","created_at":"2023-10-20 04:52:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2947910,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2826688/v1/399962a8-2d20-4e18-88ff-f9215cc1c79f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMinimally invasive surgery (MIS) for early-stage cervical cancer undergoes progressive development and acceptance since assimilation of robotic technology into gynecologic cancer surgery in 2005. Patients undergoing robotic surgery have lesser operative complications, reduced estimated blood loss (EBL) and shorter postoperative hospital stay (POHS) [\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. From 3-robotic arm [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] to adding the 4th robotic arm [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], attempts have been made to refine the practicality of robotic platform in surgery for cervical cancer. Single-port robot-assisted surgery using da Vinci Si has been looked at and was limited by crowding and collision of the robotic arms, large umbilical incision of 30\u0026ndash;40 mm, and inadequate traction with 5 mm robotic instruments [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The uptake of MIS among gynecologic oncologist plummets since 2018 Laparoscopic Approach to Cervical Cancer (LACC) trial revealed inferior 4.5-year overall survival for patients undergoing minimally invasive radical hysterectomy [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Robotic surgery comprised 16% of the trial participants hence it was difficult to extrapolate the trial result for this group [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Within the same year LACC trial release, robotic technology welcomed its new addition of da Vinci SP. The robotic system is uniquely designed for surgery via a single trocar that permits simultaneous utilization of 3 instruments and an endoscope [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Its dual-jointed robotic instruments enable freedom of movements within more confined space, and works hand in hand with the all-improved endoscopic camera [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Da Vinci SP technology is widely incorporated in urology [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and benign gynecology [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], with no study of its application in gynecologic oncology specifically for cervical cancer till date. The study aimed to present the first clinical experience and surgical outcome of robotic surgery with da Vinci SP for cervical cancer stage IA-IB.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology (STROBE) 2021 checklist was referred to as a guideline for reporting [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. The research was performed in accordance with the Declaration of Helsinki. Informed consent was acquired from each patient to undergo the surgical procedure. However, the consent for use of the patient medical information was not required due to retrospective nature of the study. This single-center cross-sectional study acquired prior Institutional Review Board approval (4-2022-1034). The recruitment occurred at Yonsei Cancer Center, a private academic tertiary referral center, involving patients undergoing robotic surgery for cervical cancer from January 2019 until December 2021. The follow-up duration was from day of operation until November 2022. Electronic health record was examined for (1) clinical characteristics such as age, parity, body mass index (BMI), histologic type, tumor size, lymphovascular space invasion, clinical stage, type of operation and harvested lymph node, (2) intra-operative surgical outcome including docking time, console time, total operation time, intra-operative complication, insertion of ancillary port, conversion to laparotomy, EBL, and uterine weight, and (3) post-operative surgical outcome such as pain score, post-operative analgesia use, urinary catheter at discharge, POHS, and post-operative complication. Inclusion criteria were patients age\u0026thinsp;\u0026ge;\u0026thinsp;18 years with histologically proven cervical cancer stage IA-IB, and underwent da Vinci SP robotic surgery as primary surgical treatment for cervical cancer. The exclusion criteria were patients undergoing da Vinci SP robotic surgery for cervical cancer after receiving neoadjuvant chemotherapy or chemoradiotherapy, patients that underwent robotic surgery with other robotic platform, and patients that did not attend post-operative follow-up in the institution. Registration number were traced from the registry of robotic operating room which was the operating room exclusive for da Vinci SP platform. Consecutive patients that underwent da Vinci SP robotic type B radical hysterectomy (RH), type C1 RH, and radical trachelectomy (RT) were included. Clinical examination and radiological imaging including computed tomography (CT) of thorax, abdomen and pelvis, magnetic resonance imaging of pelvis, and positron emission tomography (PET)/CT head to mid-thigh were performed to exclude locally advanced disease and metastases. Cervical cancer stage followed the 2018 International Federation of Obstetrics and Gynecology (FIGO) staging. Docking time was calculated from mobilization of da Vinci SP patient cart, to complete insertion of robotic instruments and endoscope into peritoneal cavity. Console time was taken from the start of robotic procedure until undocking. Pelvic and/or para-aortic sentinel lymph node sampling (SLNS) was performed using fluorescence dye indocyanine green (ICG), according National Comprehensive Cancer Network algorithm [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. Hysterectomy and trachelectomy were classified according to surgical manual of Korean Gynecologic Oncology Group [\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e]. Total operation time included the start of skin incision until completion of wound closure. Pain score was assessed according to Wong Baker Faces Pain Rating Scale at 0-hour, followed by Numerical Pain Intensity Scale at 6-, 12- and 24-hour post-operation. POHS was calculated from the day of operation until discharge. Surgical complication was defined according to Clavien-Dindo system [\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e]; these data were captured by reviewing the patients\u0026rsquo; medical record from day of operation until October 2022. Recurrence was defined as detection of new tumor growth at interval PET/CT. The confounding variable would be the surgical skill of the surgeon, which was minimized as there was only one surgeon that performed all the procedures. The effect modifier would be the histologic type of cervical cancer, which was minimized as the study only included the common histological types of cervical cancer which would respond to the treatment offered in similar fashion. Clinical characteristics of the patients were available from electronic health record at admission, and histological report of cervical biopsy as well as resected specimen. Intra-operative details of timing for docking, console time, and total operation time were searched from database of the robotic operating room, and post-operative outcome and follow-up data were available from electronic health record. BMI was measured using kilogram and meter, histologic type was reported according to World Health Organization standard of reporting and following FIGO staging. Timing for docking, console time and total operation time were recorded in 24-hour system and the duration for each variable were established by taking the time difference in minutes. Post-operative analgesia requirement was recorded as total dose used in milligram (mg). Potential bias in the study was the limited clinical documentation of the clinical events which may not capture the actual events. This bias was reduced by examining documentation entries by various health practitioners such as doctors, nurses, and allied health professionals in order to capture the necessary data variables. The study size was arrived at by successive recruitment of the patients that met the inclusion and exclusion criteria during the recruitment period. The small number may be explained by the fact that only self-paying patients could undergo the robotic procedure as it was not covered by health insurance. Quantitative variables were handled by taking the median value of the data due to small numbers of participants. Anonymized data tabulated into Microsoft Excel spreadsheet were analyzed using simple statistics to look for mean, median, range and percentage. There was no advanced statistical method used to control confounding factor, or interaction between subgroups. There was no missing data as all the information required were available in the electronic health record. There was no analytical method utilized for sampling strategy. No statistical expertise was employed, nor was there sensitivity analysis for this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePreparation before robotic procedure:\u0026nbsp;\u003c/em\u003eAll patients received glycerin and saline enema on the day before surgery. Once under general anesthesia, patient was put at lithotomy position, connected to lower limb pneumatic compression device, hand tucked to patient\u0026rsquo;s side, and shoulder strained with gel pad over clavicles. Abdominal skin and vagina were sterilized with povidone-iodine Betadine (Woodstock Sterile Solutions, Inc, Illinois, USA) 7.5% solution followed by sterile draping and bladder catheterization. After drying the umbilicus, the skin was marked with 2 dots of 23 mm distance followed by vertical incision in layers. Upon entering the peritoneum, UniPort (Dalim, Seoul, Korea) wound retractor was applied and sealed with its port cover, pneumoperitoneum developed with carbon dioxide up to 12 mm Hg, and SP robotic cannula was inserted into the UniPort channel (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The patient was moved to deep Trendelenburg position and da Vinci SP 0-degree camera (Intuitive Surgical, Sunnyvale, USA) was introduced into the peritoneal cavity. The fully-draped patient cart was advanced towards the right side of the patient and docking commenced (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The robotic arm was tilted to visualize the pelvic cavity followed by insertion of fenestrated bipolar forceps on arm 1, Cardiere forceps on arm 2, and monopolar curved scissors/cautery hook/needle driver on arm 3.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDa Vinci SP robotic procedure: SLNS and RH\u003c/em\u003e (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003eA-L). Fimbrial end of bilateral fallopian tubes were cauterized with bipolar forceps. ICG (Pulsion Medical System, Feldkirchen, Germany) of 2.5 mg/mL was injected at 3 and 9 o\u0026rsquo;clock, 3\u0026ndash;4 mm lateral to cervical os. The ICG volume injected were 1 mL at 3 mm depth, followed by another 1 mL at 20 mm depth. RUMI II with Koh-Efficient Technology uterine manipulator (Cooper Surgical, Connecticut, USA) were used in some patients. Pelvic side wall peritoneum was dissected open to develop pararectal and paravesical space. The lymphatic channels from the cervix were followed through with robotic endoscope fluorescence imaging to identify the sentinel lymph nodes. SLNS was performed, and specimen was sent for histopathological analysis. Uterine artery was coagulated, dissected at its origin, and off the underlying ureter. Uterine vein was identified and ligated with Hem-o-lok clips before cutting. Paracervix was dissected medical (type B RH) or lateral (type C RH) to the ureter, followed by opening of vesicovaginal space caudally until 10\u0026ndash;20 mm of vaginal length was exposed. Ureteric unroofing was done to roll ureter off its vaginal attachment. Pouch of Douglas peritoneum was dissected 20 mm caudal to the arch of uterosacral ligament. Bilateral salpingectomy was done, and ovarian ligament was dissected. Colpotomy was performed to include 10\u0026ndash;20 mm of vaginal cuff. Specimen was retrieved in specimen bag per vaginally. Vagina and pelvis were irrigated with warm saline followed by vaginal cuff continuous suturing with bidirectional barbed monofilament 1/0 suture Quill (Corza Medical, Massachusetts, USA).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDa Vinci SP robotic procedure: SLNS and RT\u003c/em\u003e. Except for coagulation of fimbrial end of bilateral fallopian tubes, similar steps of SLNS with RH were performed until opening of Pouch of Douglas peritoneum. Colpotomy was performed to include 10\u0026ndash;20 mm of vaginal cuff then uterine isthmus was transected to detach cervix, paracervix and vaginal cuff. The specimen was removed vaginally in a specimen bag. Vaginal cuff was sutured to the uterine isthmus by continuous suturing with 1/0 Quill following the pelvic and vaginal irrigation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHemostasis and wound closure\u003c/em\u003e: Robotic arm was undocked. Robotic endoscope was reintroduced into the peritoneal cavity and irrigation was done with warm saline. Fibrin sealant Tisseel (Baxter Healthcare Corp, Illinois, USA) was applied to pelvic raw surface for hemostasis and Guardix (Dongsung, Korea) for adhesion prophylaxis. Omentum was drawn over the bowel then pneumoperitoneum released. Rectus sheath incision was closed with interrupted suture using 1/0 Vicryl on J needle (Ethicon, USA). 10 mL of 5 mg/mL bupivacaine injection was injected subcutaneously. Umbilical skin was approximated with subdermal interrupted suture with 1/0 Vicryl on J needle (Ethicon, USA). The skin was cleaned and covered with lidocaine-embedded mesh Ridoar Gauze (Sung Kwang Pharm Co Limited, Gyeonggi-do, Korea), then sealed with waterproof bandage.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePost-operative care:\u0026nbsp;\u003c/em\u003eOnly certain patients received patient-controlled analgesia (PCA). Regular oral analgesia (non-steroidal anti-inflammatory drugs and gabapentin) was served every 6\u0026ndash;8 hours in the ward. Regular interval pain score was recorded as per nursing shift. Indwelling urinary catheter removal and discharge day was decided at daily ward review by the surgeon. Oral antibiotic and oral analgesia were provided at discharge. Patient returned to outpatient clinic in 1\u0026ndash;2 weeks to review histopathology results.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThere were 14 patients eligible for recruitment during the study period. One patient was excluded for having surgery after receiving primary chemoradiotherapy. Total 13 patients were included in the study, completed follow-up at the institution, and analyzed. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarized the characteristics of patients undergoing da Vinci SP robotic surgery in cervical cancer (n\u0026thinsp;=\u0026thinsp;13). Median age and median body mass index were 38 years old (range, 28\u0026ndash;49) and 21.6 kg/m\u003csup\u003e2\u003c/sup\u003e (range, 17.6\u0026ndash;33.6) respectively. Seven (54%) patients were nulliparous, 6 (46%) patients had previous abdominopelvic surgery, none of the patient smoke, and 7 (61.5%) patients had human papillomavirus infection. Seven (54%) patients had squamous cell carcinoma of cervix, 5 (39%) patients had adenocarcinoma and 1 (8%) patient had mixed histology of neuroendocrine and adenocarcinoma. FIGO stage IA1 was 61.5%, IB1 was 23.1%, and IB2 was 15.4%. Seven (54%) patients underwent RH and 6 (46%) patients underwent RT. All patients underwent SLNS, including one systematic lymphadenectomy. All nulliparous patients underwent fertility-preserving surgery (RT) except for one patient who had suspected synchronous tumor of endometrium and cervix. Median harvested LNs was 9 (range, 0\u0026ndash;47).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient characteristics of da Vinci SP robotic surgery in cervical cancer (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHistology\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eT diameter (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eT depth (mm)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLVSI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eFIGO stage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHarvested LN\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1B2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1B1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1B1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNE\u0026thinsp;+\u0026thinsp;AC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1B1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSCC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1B2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eC1 RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1A1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eB RH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003eAC: adenocarcinoma; BMI: body mass index; C1: type C1 hysterectomy; FIGO: International Federation of Obstetrics and Gynecology; LN: lymph node; LVSI: lymphovascular space invasion; NE: neuroendocrine; RH: radical hysterectomy; RT: radical trachelectomy; SCC: squamous cell carcinoma; T: tumor; B: type B hysterectomy\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e showed the surgical outcomes of patients undergoing da Vinci SP robotic surgery in cervical cancer. Median docking time, median console time and median total operation time were 4 minutes (range, 2\u0026ndash;9), 151 minutes (range, 75\u0026ndash;258) and 278 minutes (range, 159\u0026ndash;360) respectively. Median EBL and median uterine weight were 50 mL (range, 10\u0026ndash;100) and 148 g (range, 109\u0026ndash;185) respectively. There was no ureteric or bowel or vascular injury. No patient required ancillary port or conversion to laparotomy. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed the post-operative outcomes of da Vinci SP robotic surgery in cervical cancer. Median value for pain score was 3, 0, 0, and 0 at 0-, 6-, 12-, and 24-hour post-surgery. There were 2 (15.4%) patients who received PCA. Median Tramadol and Pethidine dosage were 50 mg (range, 0-150) and 0 mg (range, 0\u0026ndash;50) respectively. There was 1 (7.6%) patient (case 5) that was discharged home with indwelling urinary catheter which was removed at 2 weeks post-type B RH. Median POHS was 2 days (range, 2\u0026ndash;4). Case 1 (5 days post-RT) had cystitis treated with oral antibiotics. There was no post-operative ileus, umbilical hernia or infection, vaginal cuff dehiscence, and no lymphedema. All surgical margins and sentinel lymph nodes were negative for malignancy. There was one recurrence (case 3, RT for FIGO stage IB1, adenocarcinoma) on the paraaortic and left common iliac lymph nodes diagnosed at 16-month disease-free interval.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSurgical outcomes of da Vinci SP robotic surgery in cervical cancer (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDocking T (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eConsole T (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntraop compl\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal op T (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eConvert to laparotomy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAncil port\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eEBL (mL)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUterine weight (g)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e337\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e278\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e252\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003csup\u003eAncil: ancillary; compl: complication; EBL: estimated blood loss; intra\u0026minus;op: intraoperative; NA: not applicable; op: operation; T: time\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePost-operative surgical outcomes of da Vinci SP robotic surgery in cervical cancer (n\u0026thinsp;=\u0026thinsp;13)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCase\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePS 0\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePS 6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePS 12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePS 24\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePCA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTramadol (mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePethidine (mg)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIDC at discharge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ePOHS (day)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ePostop complication\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUTI\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003eIDC: indwelling urinary catheter; mg: milligram; NA: not applicable; PCA: patient\u0026minus;controlled analgesia; POHS: postoperative hospital stay; postop: post\u0026minus;operative; PS: pain score\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe feasibility of performing da Vinci SP robotic surgery lies on successful completion of the procedure via single umbilical incision. A local retrospective study of 59 patients undergoing SPL RH via 15\u0026ndash;20 mm single umbilical incision showed that all procedures were successfully completed without converting to laparotomy [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Similar surgical techniques were extended to the current study with 23\u0026ndash;25 mm umbilical incision, and all current study procedures were done without conversion to laparotomy. It goes to prove that da Vinci SP robotic platform is versatile, as it allows the surgeon to assimilate their well-established surgical method and achieve similar results with the robotic system. The advantage of da Vinci SP robotic arm is the full swivel trocar that gives surgeon the full liberty of instrument control. The robotic arm is also rotatable towards any direction within peritoneal cavity, hence no limitation to reach any surgical site. Jang et al reported lesser lymph node retrieval with single-site robotic RH which was attributed to limited accessibility to retroperitoneal space with the robotic platform [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our study, 3 patients successfully had sentinel pelvic and para-aortic lymph node sampling with no intra-operative complication, nor ancillary port insertion. The absence of other intraoperative complication was consistent with previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eShorter console time is desirable in robotic surgery to reduce the duration at deep Trendelenburg position which causes 10\u0026ndash;30% reduced cardiac output, and increases the risk of post-operative cognitive disorders [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Median console time in our study was 126 minutes, compared to 102.5 minutes and 117.5 minutes for single-site robotic RH and multiple-port robotic RH respectively [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The slightly longer console time may be ascribed to the surgeon acclimatizing with smaller working space and visual field [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Talamini et al reported that surgeon needed to perform at least 20 consecutive cases of radical prostatectomy to overcome the learning curve when adapting to da Vinci SP technology [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Studies also found that institutional learning curve notably affected the survival outcome of robotic surgery for cervical cancer [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], and the effect was especially more pronounced for tumor\u0026thinsp;\u0026ge;\u0026thinsp;20 mm [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Peritoneal entry via single umbilical incision with da Vinci SP averts the risk of damaging major anatomic structures. In retrospective by Yim et al, they found that adding the 4th robotic arm resulted in lower post-operative hemoglobin level due to wound hematoma from multiple abdominal incisions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Median EBL of 50 mL in our study reinstates the reputable reduced EBL in robotic RH. When compared to other surgical modalities, EBL in open RH was 462.27 mL [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], 145 mL in multiple-port laparoscopic RH [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], 100 mL in SPL RH [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], 120 mL in 4-arm robotic RH [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], 100 mL in 3-arm robotic RH [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and 215 mL in single-site robotic RH [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The patients were discharged after 2 days POHS with no re-admission for poorly controlled pain or other post-operative complication, which indicated that the patients tolerated the surgery very well. In cancer patient, surgical scar translates into the experience and memory of cancer diagnosis [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Leaving a small surgical scar not only result in better cosmesis, but also positively impacts in patient\u0026rsquo;s body image perception [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Umbilical incision hernia is a highlighted complication related to robotic surgery. Obesity [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], robotic surgery via single incision [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], peritoneal entry through umbilical incision [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and continuous suturing of umbilical incision [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] increased the risk of umbilical incision hernia in robotic surgery, while interrupted suture technique for umbilical incision reduced the risk of it [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The absence of umbilical incision hernia in our study is compatible with 0.5% incidence of umbilical incision hernia in laparo-endoscopic single site surgery performed via 15\u0026ndash;20 mm incision [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLimitations\u003c/strong\u003e \u003cp\u003eThe study involved small number of patients which may not capture the necessary learning curve of performing the procedure with the novel technology. All except 1 patient had BMI less than 30, hence the result cannot be inferred to obese patients with more challenging anatomic visualization, tendency to bleed from the abundance of intraperitoneal fatty tissue, and higher risk of incisional hernia. The follow-up of 9\u0026ndash;36 months post-surgery may not capture delayed complication or recurrence. We selected patients with tumor\u0026thinsp;\u0026lt;\u0026thinsp;40 mm, hence the result may not be applicable to patients with bigger tumor size.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eIn conclusion, da Vinci SP robotic RH or RT could be performed for cervical cancer stage IA-IB with good peri-operative surgical outcomes. However, larger scale randomized-controlled studies are required to assess the long the survival outcomes and benefits of performing surgery with da Vinci SP robot compared to da Vinci Xi system in cervical cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNANM and SWK contributed to the concept or design of the work. NANM and JCK contributed to the acquisition, analysis, or interpretation of data. NANM and SWK contributed to drafting or critically revising the work. NANM, JCK and SWK provided final approval of the work. All authors have agreed to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional Information (including a Competing Interests Statement)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eClair, K. H. \u0026amp; Tewari, K. S. Robotic surgery for gynecologic cancers: indications, techniques and controversies. \u003cem\u003eJ Obstet Gynaecol Res\u003c/em\u003e \u003cstrong\u003e46\u003c/strong\u003e, 828-843 https://doi.org:10.1111/jog.14228 (2020).\u003c/li\u003e\n\u003cli\u003eYim, G. W.\u003cem\u003e et al.\u003c/em\u003e Surgical outcomes of robotic radical hysterectomy using three robotic arms versus conventional multiport laparoscopy in patients with cervical cancer. \u003cem\u003eYonsei Med J\u003c/em\u003e \u003cstrong\u003e55\u003c/strong\u003e, 1222-1230 https://doi.org:10.3349/ymj.2014.55.5.1222 (2014).\u003c/li\u003e\n\u003cli\u003eGao, J.\u003cem\u003e et al.\u003c/em\u003e A Comparative Analysis of Robotic Single-Site Surgery and Laparoendoscopic Single-Site Surgery as Therapeutic Options for Stage IB1 Cervical Squamous Carcinoma. \u003cem\u003eCancer Manag Res\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 3485-3492 https://doi.org:10.2147/cmar.S299827 (2021).\u003c/li\u003e\n\u003cli\u003eVieira, M. 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A.\u003cem\u003e et al.\u003c/em\u003e Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. \u003cem\u003eHernia\u003c/em\u003e \u003cstrong\u003e20\u003c/strong\u003e, 1-10 https://doi.org:10.1007/s10029-015-1371-8 (2016).\u003c/li\u003e\n\u003cli\u003eNoh, J. J., Kim, T. H., Kim, C. J. \u0026amp; Kim, T. J. Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 17388 https://doi.org:10.1038/s41598-020-74471-5 (2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-2826688/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2826688/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDa Vinci SP robotic platform is utilized in benign gynecology, with no study of its use for cervical cancer surgery till date. The study aimed to present clinical experience and surgical outcome of da Vinci SP robotic surgery for cervical cancer stage IA-IB. This cross-sectional study involved patients undergoing da Vinci SP robotic type B radical hysterectomy (RH), type C1 RH, and radical trachelectomy (RT) from January 2019 until December 2021. Median age and body mass index were 38 years old (28\u0026ndash;49) and 21.6 kg/m\u003csup\u003e2\u003c/sup\u003e (17.6\u0026ndash;33.6) respectively. 61.5% were stage IA1, 23.1% IB1 and 15.4% IB2. 6 underwent type B RH, 1 type C RH, and 6 RT. Median docking time, console time and total operation time were 4 minutes (2\u0026ndash;9), 151 minutes (75\u0026ndash;258) and 278 minutes (159\u0026ndash;360) respectively. Median estimated blood loss was 50 mL (10\u0026ndash;100). Median pain score was 3, 0, 0, and 0 at 0-, 6-, 12-, and 24-hour post-surgery. Median postoperative hospital stay was 2 days (2\u0026ndash;4). In conclusion, da Vinci SP robotic surgery for cervical cancer stage IA-IB could be performed with good peri-operative surgical outcomes. Large scaled long-term follow-up studies are required to assess oncological outcomes of patients undergoing these procedures.\u003c/p\u003e","manuscriptTitle":"Da Vinci SP Robotic Surgery for Cervical Cancer FIGO 2018 Stage IA-IB: A Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-05-12 14:43:28","doi":"10.21203/rs.3.rs-2826688/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ebcd2ff-117b-47ed-b23f-0ae6bb4a0d37","owner":[],"postedDate":"May 12th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":21288382,"name":"Health sciences/Oncology/Surgical oncology"},{"id":21288383,"name":"Biological sciences/Cancer/Gynaecological cancer"}],"tags":[],"updatedAt":"2023-10-20T04:44:17+00:00","versionOfRecord":[],"versionCreatedAt":"2023-05-12 14:43:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2826688","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2826688","identity":"rs-2826688","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}