[Robot assisted laparoscopic staging of endometrial cancer--comparison with standard laparotomy].

OBJECTIVE: To describe our initial experience with robotically assisted laparoscopic staging of endometrial cancer patients as compared with previous cases staged by standard laparotomy. DESIGN: Original article. SETTING: Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University and University Hospital Olomouc. METHODS: The first twenty patients with early stage endometrial cancer underwent hysterectomy, bilateral salpingo-oophorectomy, and pelvic/paraaortic lymphadenectomy using four-armed da Vinci S HD surgical system (TRH) and were compared with previous 20 cases of staging procedures as done by laparotomy (TAH). Age, body mass index (BMI), clinical stage of disease, grade, histopathology, nodal yield, operative time, estimated blood loss, hospital stay, recovery room stay and analgesic needs were documented and compared. RESULTS: Mean age of patients in the robotic surgery group was 64,55 (47-85) years and in the laparotomy group 62,95 years (35-79). BMI was 27,45 (19-34) in TRH and 32,2 (26-55) in TAH group. There was no difference in FIGO stage, grade and histopathology between both groups. Node yield was slightly higher in TRH (16,95) than in TAH (14,9) group. Operative time was 262,25 min. (170-390) for TRH and 141,6 min. (97-175) for TAH. Estimates of blood loss were 102 (10-300) ml in the robotic surgery group and 352,5 (200-500) ml for TAH group. The average hospital stay was longer for the laparotomy than the robot group (8,75 vs. 7,20 days respectively). There was one conversion to laparotomy in TRH group. Within the "learning curve" gradually shortening operation time, recovery time and lowering blood loss were observed with number of performed robotic operations. CONCLUSION: Robotic hysterectomy and staging is associated with lower blood loss, lower use of narcotics and shorter hospital stay than standard laparotomy during "learning curve" period.