Introduction of a computer-based surgical platform in the surgical care of patients with newly diagnosed uterine cancer: outcomes and impact on approach.
OBJECTIVE
To assess the introduction of computer-based surgery (ie, robotic surgery [RBT]) in the treatment of patients with newly diagnosed uterine cancer.


METHODS
We identified all patients who presented to our institution for initial surgical care of newly diagnosed uterine cancer from 5/1/07-12/31/10. Perioperative outcomes of laparotomy cases were compared to those of laparoscopic (LSC) or RBT cases. Complications within 30 days of surgery were graded.


RESULTS
Of 752 patients, the planned approach was laparotomy in 103 (14%), LSC in 302 (40%), and RBT in 347 (46%). The rate of laparotomy for any reason (planned or converted) was 39% in 2007 compared to 18% in 2010 (P<0.001). Preoperative characteristics for LSC and RBT cases were similar, except 10% versus 15%, respectively, were morbidly obese (P=0.049). The extent of procedure, total nodal counts, and overall complications were similar between the LSC and RBT cases. The median length of stay was shorter for RBT cases (P<0.001). The median total room and operative times were longer for RBT cases (P<0.001), mainly due to cases in which the surgeon had less than ~40 RBT cases of experience.


CONCLUSIONS
Robotics can be efficiently introduced into the surgical care of patients with newly diagnosed uterine cancers. RBT cases require the same operative times as LSC cases after accounting for the 40-case learning curve. Both approaches result in similar excellent patient outcomes and remain reasonable approaches for this disease. The introduction of robotics may lead to further reduction in the rate of laparotomy.
Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. gynbreast@mskcc.org
Mario M
MM
Leitao
Gabriel
G
Briscoe
Kevin
K
Santos
Abigail
A
Winder
Elizabeth L
EL
Jewell
William J
WJ
Hoskins
Dennis S
DS
Chi
Nadeem R
NR
Abu-Rustum
Yukio
Y
Sonoda
Carol L
CL
Brown
Douglas A
DA
Levine
Richard R
RR
Barakat
Ginger J
GJ
Gardner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy; D008197:Lymph Node Excision / Q000379:methods; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D014594:Uterine Neoplasms / Q000601:surgery*