Outcomes of Cervical Cancer Treatment Using Total Mesometrial Resection (TMMR) Performed with the Robotic System-A...

Background/Objectives: Cervical cancer remains a major cause of cancer-related morbidity and mortality among women worldwide. The introduction of total mesometrial resection (TMMR), based on the ontogenetic compartment theory, has redefined the concept of surgical radicality in cervical cancer treatment. This study aimed to evaluate the perioperative, histopathological, and early oncologic outcomes of TMMR performed using the da Vinci Xi robotic system in patients with early-stage cervical carcinoma. Methods: A pilot, prospective, single-center study was conducted between 2021 and 2023 and included 20 consecutive patients diagnosed with Fédération Internationale de Gynécologie et d'Obstétrique (FIGO) stage IA2-IIA1 cervical carcinoma. All patients underwent robotic surgery: 4 classic radical robotic hysterectomies, 12 radical robotic hysterectomies using the TMMR technique with pelvic lymphadenectomy, and-given the young age of selected patients, fertility considerations, and tumor characteristics-4 radical trachelectomies. Surgical parameters, histopathological data, and 24-month follow-up outcomes were analyzed. Statistical analyses included Spearman's correlation, Fisher's exact test, and Mann-Whitney U test, with p < 0.05 considered statistically significant. Results: All procedures were completed robotically without conversion to laparotomy. The mean operative time was 178 ± 42 min, mean blood loss 112 ± 61 mL, and mean hospital stay 4.2 ± 1.6 days. No intraoperative complications occurred. Minor postoperative complications (Clavien-Dindo grade I-II) were observed in 10% of cases. Negative surgical margins (R0) were achieved in 17 cases, while positive margins (R+) were observed in 4 cases. Lymph node metastases were present in 20.0% of patients, and both lymphovascular space invasion (LVSI) and Vascular Endothelial Growth Factor (VEGF) expression were detected in 33.3%. No significant correlations were found between VEGF expression, LVSI, or nodal status. During the 24-month follow-up period, no local or distant recurrences were documented. Conclusions: Robotic TMMR for early-stage cervical cancer is feasible, safe, and provides complete oncologic radicality with low perioperative morbidity. Although these preliminary results are promising, larger multicenter studies are needed to validate long-term oncologic outcomes and to establish standardized protocols for robotic compartment-based surgery.