title: Comparison of perioperative outcomes and complication rates between conventional versus robotic-assisted laparoscopy in the evaluation and management of early, advanced, and recurrent stage ovarian, fallopian tube, and primary peritoneal cancer.
abstract: OBJECTIVE
  The objective of this study was to examine perioperative outcomes, including complication rates, of conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RALS) in the evaluation and management of early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer.
  
  
  METHODS
  This is a retrospective analysis of a prospectively maintained database of surgery performed from July 2008 to December 2012. Sixty-three women had 83 surgeries performed; 22 surgeries for early-stage disease (International Federation of Gynecology and Obstetrics stage I) and 61 for advanced and/or recurrent disease.
  
  
  RESULTS
  Of the 22 for early stage, 10 were CL, 9 were RALS, and 3 were laparoscopy converted to laparotomy (LP). There was no significant difference between CL and RALS in estimated blood loss (EBL, P = 0.27) or length of stay (LOS, P = 0.43); however, both had significantly less EBL (P = 0.03 and 0.03, respectively) and LOS (P = 0.03 and 0.03) than LP. There was no difference in OR time among the groups (P = 0.79). One patient (33%) had an intraoperative complication in LP. One patient (10%) had a postoperative complication in CL, 2 (22%) in RALS, and 1 (33%) in LP, with no significant difference (P = 0.61).Among the 42 patients with advanced/recurrent disease, 61 surgeries were performed: 14 diagnostic procedures and 47 cytoreductive surgeries. Of the 47, there was no difference in operating room time (P = 0.10). There was no difference in EBL or LOS between CL and RALS (P = 0.82, P = 0.87); however, both were less in CL (P < 0.001 and P = 0.02) and RALS (P = 0.01 and P = 0.02) compared with LP. There were 5 (63%) intraoperative transfusions in LP and none in CL or RALS. When including all surgeries for advanced/recurrent disease, there was 1 intraoperative complication (12%) in LP. There was no difference in postoperative complications between groups (P = 0.89); 8 patients (19%) had postoperative complications in CL, 2 (18%) in RALS, and 2 (25%) in LP. Overall, there were no grade 4 or 5 complications and no perioperative or intraoperative deaths.
  
  
  CONCLUSIONS
  In our experience, perioperative outcomes are comparable between CL and RALS in both early and advanced/recurrent disease and not inferior to laparotomy, making CL and RALS an acceptable approach in selected patients.
authors.affiliation: *St Luke's Roosevelt Hospital, Columbia University, New York; †Winthrop University Hospital, Mineola; and ‡New York Downtown Hospital, Weill Cornell Medical College, New York, NY; §Etlik Zubeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey; and ∥Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Farr Reza
authors.initials: FR
authors.lastname: Nezhat
authors.forename: Tamara Natasha
authors.initials: TN
authors.lastname: Finger
authors.forename: Patrick
authors.initials: P
authors.lastname: Vetere
authors.forename: Amir Reza
authors.initials: AR
authors.lastname: Radjabi
authors.forename: Mario
authors.initials: M
authors.lastname: Vega
authors.forename: Lauren
authors.initials: L
authors.lastname: Averbuch
authors.forename: Susan
authors.initials: S
authors.lastname: Khalil
authors.forename: Sadiman Kiykac
authors.initials: SK
authors.lastname: Altinbas
authors.forename: Daniel
authors.initials: D
authors.lastname: Lax
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005185:Fallopian Tube Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D059035:Perioperative Period; D010534:Peritoneal Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome