Nerve-sparing robotic radical hysterectomy: our technique

Robotic surgery is now becoming accepted for treatment of gynaecological malignancies. Nerve preservation during radical hysterectomy is increasingly being offered due to improved post-operative bladder and sexual function. We aimed to demonstrate the feasibility of performing a nerve-sparing radical hysterectomy robotically and to assess the oncological and functional outcomes associated with this surgery. Between August 2011 and January 2013, a total of 12 non-consecutive patients underwent robotic surgery for early stage cervical cancer at our institution. Patients comprising FIGO stage IA2 to IB1 were treated with nerve-sparing robotic radical hysterectomy using a C1 (Querleu-Morrow classification) type technique. The feasibility, operative time, blood loss, oncological outcome and post-operative bladder function were assessed. All the procedures were completed robotically without conversion to laparoscopy or laparotomy. The mean age of the patients was 56 years (range 44-76) and their mean body mass index was 22.6 kg/m(2) (range 18.1-26.4). The mean operative time was 156 min (range 120-250); the mean blood loss was 120 ml (50-250). The Foley catheter was removed on the third post-operative day, with full recovery of bladder function in all patients except one who required prolonged catheterisation for 3 weeks. Residual urine was 40 ml (range 30-80). Parametrial margins of 2.5-3 cm, distal vaginal margins of 2-2.5 cm and a mean nodal harvest of 24 (range 18-30) were achieved. The mean hospital stay was 3 days (range 2-6). The median follow-up is 12 months. There is no loco-regional recurrence. All the patients are sexually active. Robotic nerve-sparing radical hysterectomy is technically feasible to perform, and is oncologically safe for early stage cervical carcinoma.