title: Robot versus laparoscopic nerve-sparing radical hysterectomy for cervical cancer: a comparison of the intraoperative and perioperative results of a single surgeon's initial experience.
abstract: OBJECTIVE
  The aim of the study was to compare the initial surgical outcomes and learning curve of nerve-sparing robotic radical hysterectomy (RRH) with nerve-sparing total laparoscopic radical hysterectomy (TLRH) for the treatment of early-stage cervical cancer in the first 50 cases.
  
  
  METHODS
  Between January 2008 and March 2012, 50 consecutive patients underwent nerve-sparing RRH. These patients were compared with a historic cohort of the first 50 consecutive patients who underwent nerve-sparing TLRH.
  
  
  RESULTS
  Both groups were similar with respect to patients and tumor characteristics. The mean operating time in the RRH group was significantly longer than that in the TLRH group (230.1 ± 35.8 vs 211.2 ± 46.7 minutes; P = 0.025). The mean blood loss for the robotic group was significantly lower compared with the laparoscopic group (54.9 ± 31.5 vs 201.9 ± 148.4 mL; P < 0.001). There was no significant difference in the mean pelvic lymph nodes between the 2 groups (25.0 ± 9.9 vs 23.1 ± 10.4; P = 0.361). The mean days to normal residual urine were 9.6 ± 6.4 in RRH and 11.0 ± 6.2 in TLRH (P = 0.291). The incidence of intraoperative complication was profoundly lower in RRH compared with that of TLRH (0% vs 8%; P = 0.041). Moreover, no intraoperative transfusion was required in RRH, whereas 4 (8%) were required in TLRH (P = 0.041). In both groups, we found no evidence of a learning effect during the first 50 cases.
  
  
  CONCLUSIONS
  During the first 50 cases, surgical outcomes and complication rates of nerve-sparing RRH were found to be comparable to those of nerve-sparing TLRH. Moreover, the mean blood loss and intraoperative complication rate in the robotic group were significantly lower than those in the laparoscopic group. Surgical skills for nerve-sparing TLRH easily and safely translated to nerve-sparing RRH in case of experienced laparoscopic surgeon.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Gun Oh
authors.initials: GO
authors.lastname: Chong
authors.forename: Yoon Hee
authors.initials: YH
authors.lastname: Lee
authors.forename: Dae Gy
authors.initials: DG
authors.lastname: Hong
authors.forename: Young Lae
authors.initials: YL
authors.lastname: Cho
authors.forename: Il Soo
authors.initials: IS
authors.lastname: Park
authors.forename: Yoon Soon
authors.initials: YS
authors.lastname: Lee
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D017776:Autonomic Pathways / Q000473:pathology / Q000601:surgery*; D018196:Carcinoma, Adenosquamous / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007001:Hypogastric Plexus / Q000473:pathology / Q000601:surgery; D007044:Hysterectomy; D007431:Intraoperative Complications; D010535:Laparoscopy; D059032:Learning Curve; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D059035:Perioperative Period; D010820:Physicians; D011379:Prognosis; D012371:Robotics; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*