title: Telelap ALF-X vs Standard Laparoscopy for the Treatment of Early-Stage Endometrial Cancer: A Single-Institution Retrospective Cohort Study.
abstract: OBJECTIVE
  To compare the surgical and clinical outcomes of patients affected by early-stage endometrial cancer treated using the Telelap ALF-X platform versus conventional laparoscopic surgery.
  
  
  METHODS
  Single institution retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome, Italy.
  
  
  METHODS
  The study involved 89 patients affected by early-stage endometrial cancer who underwent elective surgical staging between October 2013 and September 2014. Among them, 43 (48.3%) underwent Telelap ALF-X staging (ALF-X group), and 46 (51.7%) underwent conventional laparoscopic staging (laparoscopic group).
  
  
  METHODS
  All selected patients underwent laparoscopic staging with radical hysterectomy (class A sec Querleu-Morrow), bilateral salpingo-oophorectomy, and pelvic lymphadenectomy if required. The 2 surgical groups were further divided into patients who did not require pelvic lymphadenectomy (subgroup 1) and those who underwent pelvic lymphadenectomy (subgroup 2).
  
  
  RESULTS
  In the ALF-X group, the median operative time was 128 minutes (range, 69-260 minutes) for subgroup 1 and 193 minutes (range, 129-290 minutes) for subgroup 2. In the laparoscopic group, the median operative time was 82 minutes (range, 25-180 minutes) in subgroup 1 and 104 minutes (range, 36-160 minutes) in subgroup 2. The difference in operative time between subgroups was statistically significant in both the ALF-X and laparoscopic groups (p = .000). In subgroup 1 of the ALF-X group, there was 1 conversion to standard laparoscopy (2.3%) and 2 conversions to laparotomy (4.7%) (p = .234). No conversions to laparotomy occurred in the laparoscopic group. Postoperative complications included 1 case of pelvic hematoma (2.3%) in subgroup 1 of the ALF-X group and 1 case of subocclusion and 1 case of pulmonary edema (4.3%) in subgroup 1 of the laparoscopic group.
  
  
  CONCLUSIONS
  Based on operative outcomes and complication rates, our results suggest that the Telelap ALF-X approach is feasible and safe for endometrial cancer staging; however, further studies are needed to definitively assess the role of Telelap ALF-X early-stage endometrial cancer staging.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: gueliallettis@gmail.com.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gueli Alletti
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rossitto
authors.affiliation: Department of General Surgery and Medical Surgical Specialties, Gynecologic Clinic, University of Catania, Catania, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Cianci
authors.affiliation: Institute for Maternal and Child Health-IRCCS Burlo Garofolo, University of Trieste, Trieste, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Restaino
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Costantini
authors.affiliation: Department of Medicine and Aging Sciences, G. D'Annunzio University of Chieti-Pescara, Chieti and Pescara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fanfani
authors.affiliation: Division of Minimally Invasive Gynecology, St. Maria Hospital, University of Perugia, Terni, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Fagotti
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cosentino
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000368:Aged; D000818:Animals; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D007558:Italy; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data*; D008197:Lymph Node Excision / Q000295:instrumentation* / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods; D016896:Treatment Outcome
keywords: ALF-X; Endometrial cancer; Endoscopy; Laparoscopy; Robotic surgery