Robot-assisted versus conventional laparoscopic hysterectomy in endometrial cancer: An observational study in a French tertiary teaching hospital at the beginning of the learning curve

Abstract

Introduction

The role of Robotic Assisted Laparoscopy (RAL) versus conventional laparoscopy (CL) in the surgical treatment of endometrial cancer remains a matter of debate. We aimed to compare RAL and CL in terms of clinical outcomes (hospital stay characteristics and 3-month complications) in patients undergoing hysterectomy for endometrial cancer.

Materials and Methods

We conducted a single-center, retrospective study in a tertiary teaching hospital comparing two groups of women who underwent hysterectomy for endometrial carcinoma by RAL performed by a surgeon during the beginning of learning curve, or CL.

Results

Of the 110 patients included, 56 were in the RAL group and 54 in the CL group. The patients in the RAL group were significantly older (71.6±8.7 vs 67.8±9.7, p=0.031) and had a higher BMI (33.1±7.0 vs 29.8±6.1, p=0.030) than those in the CL group. Operating room occupancy time was higher with RAL (4.6 hours±1.3 vs 3.5±1.3, p<0.001). Although less spinal analgesia was used in the RAL group (35% vs 74%, p<0.001), the patients in this group consumed less postoperative paracetamol (9.4g±5.3 vs 13.0±9.9, p=0.032) meaning faster recovery. Conversely, there was a higher rate of unplanned consultations during the 3-month follow-up in the RAL vs CL group (18.5% vs 3.6%, p=0.012).

Discussion

RAL was associated with less postoperative pain even at the beginning of learning curve. Surgeons were more likely to perform RAL than CL for older and/or obese patients, suggesting they intuitively consider RAL of added benefit for these patients.