Robotic Assisted, Total Laparoscopic, and Total Abdominal Hysterectomy for Management of Uterine Cancer.
OBJECTIVE
The purpose was to compare robotic assisted total laparoscopic hysterectomy (TRH), laparoscopic assisted hysterectomy (TLH) and total abdominal hysterectomy (TAH) with surgical staging +/- lymphadenectomy for the management of uterine cancer.


METHODS
Institutional review board approval was obtained and patient characteristics, pathologic data, and data related to the surgical procedure were collected from chart review. Data were analyzed with SAS statistical software.


RESULTS
A total of 102 TRHs were compared to 115 TLHs and 79 TAHs. There were more grade I and endometrial intraepithelial (EIN) lesions in the preoperative pathology of TLHs (P< 0.01). Pelvic lymphadenectomy was performed in 71 (70%) TRH, 46 (58%) TAH, and 28 (24%) TLH cases (P< 0.01). Mean surgical time was 203, 133 and 132 minutes for TRHs, TLHs, and TAHs (P< 0.05). Estimated blood loss was 69, 86, and 215 ml for TRH, TLH, and TAH (P< 0.05). Blood transfusions were 19% in TAHs versus 3% and 2% in TLHs and TRHs (P< 0.01). There were fewer wound infections (2% vs. 10%) in TRHs versus TAHs (P< 0.01). Length of stay was shorter for the TRH and TLH groups (P< 0.05).


CONCLUSIONS
Despite longer surgical times, benefits of minimally invasive technology included shortened length of stay, decreased wound infections, transfusions, and blood loss. In our population, procedure selection for TLH versus TRH may have been influenced by lower preoperative grade, with reservation of robotic technology for cases anticipated to be more complex, and therefore justifying increased technology costs and operating times.
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Nevadunsky
N
Nicole
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Clark
C
Rachel
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA ; Gillette Center for Women's Cancer, Dana-Farber Harvard Cancer Center, Boston, USA.
Muto
M
Michael
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA ; Gillette Center for Women's Cancer, Dana-Farber Harvard Cancer Center, Boston, USA.
Berkowitz
B
Ross
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Ghosh
G
Sue
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Vitonis
V
Allison
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA ; Gillette Center for Women's Cancer, Dana-Farber Harvard Cancer Center, Boston, USA.
Feltmate
F
Colleen
Endometrial Cancer; Laparoscopy; Robotics