A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy.

OBJECTIVE: To compare robotic radical hysterectomy to laparoscopic and radical abdominal hysterectomy in the treatment of cervical cancer.

METHODS: Prospective analyses of thirty-two consecutive patients undergoing robotic radical hysterectomy were compared to 17 patients undergoing laparoscopic radical hysterectomy and 14 patients undergoing radical abdominal hysterectomy.

RESULTS: Operative time for the robotic group was 2.4 h+/-0.8 and not significantly different from the laparoscopic group at 2.2 h+/-0.7, nor the laparotomy group (1.9 h+/-0.6, p=0.05). The estimated blood loss for patients undergoing robotic hysterectomy was 130 cm(3) +/-119.4. This was significantly less than the laparotomy group (621.4 mL+/-294.0, p<0.0001), but not the laparoscopic group (209.4 mL+/-169.9, p=0.09). The robotic group had an average of 32.4 total nodes retrieved, as compared to 18.6 and 25.7 nodes retrieved in the laparoscopy and laparotomy cohorts, respectively. All differences were significant (p<0.0001 and p<0.05). Mean length of hospital stay was 2.6, 2.3 and 4.0 days in the robotic, laparoscopic, and laparotomy cohorts respectively. The incidence of postoperative complications was less in the robotic cohort (18.8%) as compared to the laparoscopic (23.5%), and laparotomy cohorts (28.6%).

CONCLUSIONS: Robotic total laparoscopic radical hysterectomy with pelvic and para-aortic lymphadenectomy is feasible and may be preferable over laparoscopic or radical abdominal hysterectomy.