title: Robot-assisted total preservation of the pelvic autonomic nerve with extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy for cervical cancer.
abstract: OBJECTIVE
  To evaluate our short-term clinical outcomes of robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy as part of nerve-sparing radical hysterectomy.
  
  
  METHODS
  Between March 2011 and June 2012, we observed prospectively 28 consecutive patients who underwent robot-assisted autonomic nerve-sparing extended systematic lymphadenectomy, including the superior and inferior gluteal, presacral (subaortic), common iliac, and lower para-aortic nodes.
  
  
  RESULTS
  The predominant International Federation of Gynecology and Obstetrics stage was IB1 (15 patients), followed by IB2 (5 patients), IA2 (3 patients), IIA1 (3 patients), and IIA2 (2 patients). The mean ± SD total operating time was 308.8 ± 54.9 minutes, and the mean ± SD console time was 280.0 ± 46.0 minutes. The mean ± SD blood loss was 102.7 ± 153.8 mL. The mean ± SD acquired pelvic lymph node was 27.1 ± 9.3, the mean ± SD extended lymph node was 19.2 ± 9.6, and the mean ± SD total lymph node was 46.3 ± 14.5. A total of 10 patients (35.7%) had nodal metastasis; among them, 6 patients (21.4%) had single pelvic nodal metastasis, 3 patients (10.7%) had concurrent pelvic and extended nodal metastasis, and one patient (3.6%) had single extended nodal metastasis. No intraoperative complications that required treatment occurred; however, ureterovaginal fistula was identified in 4 patients (14.3%) and ureter stricture in 4 patients (14.3%) after radiotherapy. After a median follow-up of 10 months (range, 1-16 months), there was no pelvic recurrence; however, one patient had recurrence at transposition site of ovary.
  
  
  CONCLUSIONS
  With the advantage of delicate movement of robot instrument, robot-assisted systematic extended lymphadenectomy with total preservation of pelvic autonomic nerves did not compromise the radicality, and its surgical technique was feasible and safe. By using this approach, we could harvest more lymph nodes and have a high rate of metastatic nodes without disturbing voiding function; however, there was increased rate of urological complications. Moreover, long-term survival benefit after an extended systematic lymphadenectomy must be evaluated.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University Medical Center, Daegu, Korea. yslee@knu.ac.kr
authors.forename: Yoon Soon
authors.initials: YS
authors.lastname: Lee
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
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; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D011446:Prospective Studies; D012371:Robotics; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*