The impact of robotics on practice management of endometrial cancer: transitioning from traditional surgery.
BACKGROUND
Evaluation of the impact of a new robotic surgery programme on perioperative outcomes for endometrial cancer


METHODS
A prospective database of all patients undergoing staging for endometrial cancer during July 2007-July 2008 was collected and analysed. Demographic data and perioperative outcomes were compared between cases performed via laparotomy, laparoscopy and robotics.


RESULTS
Sixty-five patients underwent staging during the time of data collection (LAP-26, LSC-7, ROB-32). No difference in surgical volume in the year before vs. after robotics was identified. Median operative time for robotics and laparotomy was significantly less than for laparoscopy (p = 0.023). There was no significant difference in lymph node yields between the three groups (p = 0.92). Robotics was associated with significantly less blood loss (p < 0.0001). Complication rates were significantly lower in the robotic group compared to the laparotomy group (p = 0.05). Median hospital stay was 1 day for the minimally invasive groups. Total number of perioperative inpatient days decreased from 331 to 150 in one year. Practice management of endometrial cancer transitioned from a predominantly open approach (5.6% LSC) to robotics (11% LSC, 49% ROB) within 12 months.


CONCLUSIONS
Robotic surgery dramatically altered our management of endometrial cancer and was associated with a significant improvement in several perioperative outcomes when compared to laparotomy and laparoscopy.
Hoekstra
Anna V
AV
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, 250 East Superior Street, Chicago, IL 60611, USA.
Jairam-Thodla
Arati
A
Rademaker
Alfred
A
Singh
Diljeet K
DK
Buttin
Barbara M
BM
Lurain
John R
JR
Schink
Julian C
JC
Lowe
M Patrick
MP
D002641:Chicago / Q000453:epidemiology; D055356:Endometrial Ablation Techniques / Q000706:statistics & numerical data*; D016889:Endometrial Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012371:Robotics / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*