Operative and anesthetic outcomes in endometrial cancer staging via three minimally invasive methods

The aim of this work is to compare operative and anesthetic outcomes in patients undergoing minimally invasive endometrial cancer staging, with lymphadenectomy performed via transperitoneal, extraperitoneal, or robotic-assisted methods. Sixty-six consecutive patients (24 transperitoneal, 19 extraperitoneal, and 23 robotic) were identified who underwent laparoscopic-assisted endometrial cancer staging with pelvic and para-aortic lymphadenectomy. Patients were divided into three groups based on method of para-aortic lymphadenectomy. Anesthetic and surgical times were longest in the extraperitoneal group. Patients undergoing robotic surgery had the shortest hospital stay and lowest conversion rate to laparotomy. Patients undergoing robotic lymphadenectomy had more pelvic and para-aortic nodes removed compared with the transperitoneal method. There was no difference in number of para-aortic nodes removed in the robotic versus extraperitoneal methods. The extraperitoneal group had highest peak end-tidal CO2 levels and highest narcotic requirements, while patients in the robotic group had highest peak inflation pressures and lowest pain scores. There were no differences in complication rates amongst the three groups. Robotic-assisted staging is superior to other minimally invasive methods in terms of most operative outcomes. Extraperitoneal lymphadenectomy is equivalent to robotic surgery where number of aortic nodes is concerned, but is associated with higher end-tidal CO2 levels and narcotic requirements. Peak inflation pressures were highest in the robotic group, with no apparent adverse consequences.