Comparison of a novel surgical approach for radical hysterectomy: robotic assistance versus open surgery

To report the learning curve and perioperative outcomes for robotic radical hysterectomy using a unilateral surgical approach transferred directly from one surgeon's open radical hysterectomy experience, thirty-two consecutive robotic radical hysterectomy cases (10/2006-1/2009) were contrasted to a cohort of 20 consecutive open radical hysterectomies (2/2005-2/2008). Perioperative characteristics compared included operative time, number of nodes, estimated blood loss, length of hospital stay, and complications. Robotic operative times were significantly longer than for open (122.1 ± 33.0 versus 67.5 ± 16.2 min, P < 0.0001), but decreased with experience, going from 156.0 min for the first eight robotic cases to 95.0 min for the last eight cases (P < 0.05). Blood loss (99.2 ± 46.2 mL versus 275.0 ± 206.0 mL, P < 0.0001) and length of hospital stay (1.7 versus 5.2 days, P < 0.001) were significantly lower for the robotic cohort. Lymph node yield in the robotic cohort was equivalent to that for the open cohort (11.5 versus 9.2, P = 0.1446), and complication rates were 21.9% for robotic and 30.0% for open radical hysterectomy. Implementing a unilateral approach to maximize surgical efficiency greatly reduced surgical times without compromising patient morbidity, bringing robotic operative times while still within the learning curve close to those for open radical hysterectomy. Thus, robotic radical hysterectomy may soon be considered the preferred standard front-line therapy for cervical cancer.