title: Comparison of perioperative outcomes and cost of robotic-assisted laparoscopy, laparoscopy and laparotomy for endometrial cancer.
abstract: OBJECTIVE
  To analyze the perioperative outcomes and cost of three surgical approaches in the treatment of endometrial cancer: robotic, laparoscopy and laparotomy.
  
  
  METHODS
  We studied 347 patients with endometrial cancer treated in a single institution: 71 patients were operated by robotics, 84 by conventional laparoscopy and 192 by laparotomy. All patients underwent total hysterectomy, bilateral salpingoophorectomy and pelvic and para-aortic lymphadenectomy depending on the pathological features.
  
  
  RESULTS
  Operative time was longer in the laparoscopy group as compared to robotics and laparotomy (218.2 min, 189.2 min, and 157.4 min respectively, p=0.000). The estimated blood loss was lower in the robotic group relative to the other groups (99.4 ml in robotic, 190.0 ml in laparoscopy and 231.5 ml in laparotomy, p=0.000). Similar findings were observed for the pre- and post-operative mean hemoglobin levels (-1.3g/dl, -2.3g/dl and -2.5 g/dl respectively, p=0.000), and transfusion rate (4.2%, 7.1% and 14.1% respectively, p=0.036). The length of hospital stay was higher in the laparotomy group compared to robotics and laparoscopy (8.1, 3.5 and 4.6 days respectively; p=0.000). The conversion rate to laparotomy was lower for robotics (2.4% for robotics and 8.1% for laparoscopy, p=0.181). Overall complications were similar for robotics and laparoscopy (21.1%, 28.5%) (p=0.079). Robotic complications were significantly lower as compared to laparotomy (21.2 vs 34.9% (p=0.036). No differences were found relative to disease-free or overall survival among the three groups. The global costs were similar for the three approaches (p=0.566).
  
  
  CONCLUSIONS
  Robotics is a safe alternative to laparoscopy and laparotomy for endometrial cancer patients, offering improved perioperative outcomes and similar cost as compared to the other two surgical approaches.
authors: Department of Obstetrics and Gynecology, Hospital Clínico San Carlos, Complutense University of Madrid, Spain. pcoronadom@sego.es
authors: Pluvio J
authors: PJ
authors: Coronado
authors: Miguel A
authors: MA
authors: Herraiz
authors: Javier F
authors: JF
authors: Magrina
authors: María
authors: M
authors: Fasero
authors: Jose A
authors: JA
authors: Vidart
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D016889:Endometrial Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics; D010535:Laparoscopy / Q000191:economics*; D007813:Laparotomy / Q000009:adverse effects / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D012371:Robotics / Q000191:economics*